Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter?
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.
['Diaz|Alfonso Rodriguez|AR|', "Reina|Carlos O'Connor|CO|https://orcid.org/0000-0002-1670-4235", 'Plaza|Guillermo|G|', 'Posadas|Elena Rodriguez|ER|', 'Arevalo|Francisco Valdeon|FV|', 'Iriarte|Maria Teresa Garcia|MTG|']
D000273:Adipose Tissue D000328:Adult D000556:Ambulatory Surgical Procedures D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D009225:Myringoplasty D009333:Neck D011446:Prospective Studies D016896:Treatment Outcome D014432:Tympanic Membrane D018058:Tympanic Membrane Perforation
fat graft hearing loss middle ear surgery office surgery tympanoplasty