Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter?

Abstract

Objective: To assess clinical and functional outcomes of a fat graft myringoplasty under local in an office setting. Study Design: Prospective case series. Setting: Tertiary care facility. Patients: Patients with a tympanic membrane (TM) perforation presenting between December 2005 and June 2019. Inclusion criteria included perforation size >25% of the surface of the pars tensa of the TM, entire perforation margins visualized through a transcanal view, and lack of spontaneous closure at the 6-month follow-up. The exclusion criteria were the presence of cholesteatoma, wet appearance of the mucosa in the tympanic cavity, ear discharge in the 3 months before surgery, or signs of ossicular inconsistency. Intervention: In-office fat graft myringoplasty technique under local anesthesia. Main outcome Measures: Complete perforation closure rate and audiometric outcomes. Results: A total of 121 patients underwent the procedure, of whom 21 had bilateral sequential procedures (total 142 ears). Average age was 51.1 ± 18.4 years (range, 3-78 years). The size of perforation was <25% of TM in 39 (27.5%) ears, 25% to 50% of TM in 49 (34.55%) ears, 50% to 75% of TM in 34 (23.91%) ears, and 75% to 100% of TM in 20 (14.10%) ears. Complete perforation closure was evident in 130 (91.55%) of the 142 ears. Preoperative mean air conduction threshold was 59.3 dB (17-95 dB) and significantly improved into 35.6 dB (10-85 dB; P < .0004) after surgery. Preoperative air–bone gap was 30.2 dB (5-70 dB) and also significantly improved into 10.2 dB (5-65 dB; P < .0001) after surgery. Conclusion: In office fat graft myringoplasty, in adult and pediatric patients with variable perforation sizes, is a well-tolerated procedure with very satisfactory clinical results.

Comparing Myringoplasty to Type I Tympanoplasty in Tympanic Membrane Repair: A Systematic Review and Meta‐analysis

“…The full‐text review was performed on 709 studies, of which 624 were excluded for reasons such as failure to report TM perforation size, inability to stratify outcomes by perforation size, incorrect graft type, and no free full‐text. Following a thorough full‐text review, 85 studies were eventually selected for having met full inclusion criteria 10,14,15,17,18,25‐104 . A comprehensive overview of the search process is detailed in the corresponding PRISMA diagram (Figure 1).…”

Butterfly Cartilage Tympanoplasty as an Alternative to Conventional Surgery for Tympanic Membrane Perforations: A Systematic Review and Meta-Analysis

“…Particularly, one-session BCT endoscopic surgeries can be performed simultaneously in patients with bilateral perforations, 40,41 which reduces the pain, risks, and costs associated with 2 separate operations. [40][41][42] For surgeons, the BCT technique is easy to learn and perform. Stekelenburg et al indicated that butterfly grafts had good success rates when used by both experienced surgeons (87.1%) and intermediate surgeons (88.9%).…”

Middle Ear Packing and External Ear Packing with Fibrin Glue Enhances the Success of Fat Myringoplasty without Hyaluronic Acid Disc

“…Fat myringoplasty appears safe and suitable for stable, dry, small sized perforations or geriatric patients with underlying disease. Since Ringerberg [1] introduced for the first time, it has been accepted successful technique for small TMP and geriatric patients [2][3][4]. According to the publicated reports, average success rate of fat myringoplasty has been reported from 72.9% to 92.2% [2,[5][6][7][8][9][10].…”