CLINICAL OUTCOME OF FAT MYRINGOPLASTY IN SELECT DRY CENTRAL PERFORATIONS: A SIZE-BASED ANALYSIS

Abstract

Background: Fat graft myringoplasty (FGM) is a minimally invasive technique utilized for the closure of small to moderate tympanic membrane perforations, particularly in cases of chronic suppurative otitis media (CSOM). This technique employs autologous fat harvested typically from the ear lobule and is considered a simple, suture-less, and outpatient procedure. FGM is particularly advantageous due to its reduced operative time, minimal morbidity, and effective anatomical and functional outcomes.

Objective: To evaluate the efficacy of fat graft myringoplasty in terms of graft uptake and hearing improvement in patients with small central perforations of the tympanic membrane.

Methodology: The present prospective interventional study was conducted in the Department of ENT, Tertiary Care Hospital, over a period of 18 months from February 2017 to July 2018. A total of 50 patients aged 15–70 years, with dry, small to moderate-sized central tympanic membrane perforations, were enrolled. All patients underwent fat graft myringoplasty using autologous fat harvested from the ear lobule. The procedure was performed via a transcanal approach under local anesthesia. After freshening the perforation margins and topical preparation, the fat graft was inserted medial to the tympanic membrane remnant. The patients were followed up postoperatively on day 7, day 14, 1 month, 3 months, and 6 months for graft uptake and hearing assessment. Hearing was evaluated by Rinne tuning fork test and pure tone audiometry. All procedures were performed under supervision of experienced ENT surgeons.

Results: Among the 50 patients, 60% were male and 40% were female. The most affected age group was 31–40 years (36%). The overall graft uptake rate at six months was 88%, with only 12% graft failures. Audiological improvement was noted in 88% of cases, with a significant number showing Rinne conversion from negative to positive and 52% achieving hearing gain between 11–20 dB.

Conclusion: Our study concludes that fat graft myringoplasty is an effective, minimally invasive alternative to conventional myringoplasty techniques, with high graft uptake rate and significant hearing improvement, especially suitable for small central perforations in selected cases.