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Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter?
Alfonso Rodriguez Diaz1, Carlos O'Connor Reina2, Guillermo Plaza3
1Hospital Naval de San Carlos, Otorhinolaryngology Department Hospital Naval de San Carlos, San Fernando Cadiz, Spain.
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.
