Mediterr. J. Otol 2007; 3:(3) 120-125

Fat Graft Myringoplasty: An Office Procedure for the Repair of Small Perforations of the Tympanic Membrane
 

Gian Antonio Bertoli, Marco Barbaro, Valerio Giangrande, Gianluca Bava, Elio De Seta, Roberto Filipo 

Department of Otolaryngology and Neurology, University of Rome “La Sapienza,” Rome, Italy, drbertoliga@tim.it

OBJECTIVE: Perforations of the tympanic membrane are treated with various surgical techniques and materials, all of which have advantages and disadvantages. Although  autologous temporalis fascia is most often used to repair a perforated tympanic membrane, a fat graft can also be used, and fat myringoplasty (FM) is a simple and cost-effective technique. The aim of our study was to determine the effectiveness of FM in tympanic membrane repair, particularly with respect to the size and site of the perforation. Suggestions for optimizing the outcome of FM with selection criteria and the careful choice of surgical technique are presented.

MATERIALS AND METHODS: Seventy-three patients (29 men and 44 women) in whom as much as one-quarter of the pars tensa had been perforated underwent FM as an office procedure. The outcome of that procedure in each subject was evaluated 1 week, 1 to 6 months, and 1 year after surgery.

RESULTS: One year after surgery, 80.8% of perforations were closed. The closure rates for small perforations were higher than those for large perforations (93.7% vs 70.7%), and posterior perforations had better closure rates (90.5%) than did anterior perforations (67.7%). The results of FM performed for revision tympanoplasty were poor (52.9%).

CONCLUSION: The results of our study emphasize the importance of carefully evaluating the remnant eardrum so that the actual size of the perforation can be determined. FM could be considered the treatment of choice for the repair of small posterior and inferior perforations of the tympanic membrane.