Advantages of Hyaluronic Acid Fat Graft Myringoplasty Over Fat Graft Myringoplasty

Objectives: To compare hyaluronic acid fat graft myringoplasty (HAFGM) with fat graft myringoplasty (FGM) on grade I tympanic membrane perforations (TMPs) (<25% of the tympanic membrane surface) and to assess 12-month postoperative hearing outcomes in a pediatric population. Design: Prospective study. Setting: Tertiary care pediatric center. Patients: Ninety-two children with a TMP were included in the study and were operated on using either the HAFGM (n=50) or FGM (n=42) technique. Age at surgery ranged from 4 to 17 years (mean age, 11.52 years). Interventions: Hyaluronic acid fat graft myringoplasty is a new technique for TMP repair in a pediatric population and is performed using local anesthesia at the outpatient office. Main Outcome Measures: Postoperative status of the tympanic membrane, hearing improvement, and incidence of complications. Results: Successful closure of the tympanic membrane was achieved in 90% of the HAFGM group and in 57.1% of the FGM group (P=.004). The mean (SD) postoperative air-bone gap in the HAFGM (6.86 [8.52] dB) group was significantly lower than in the FGM (18.32 [13.44] dB) group (P<.002). The mean postoperative follow-up time was 31.5 and 34.7 months for HAFGM and FGM groups, respectively. No difference was observed between children 10 years or younger and children older than 10 years. In the 2 groups, no postoperative complications were observed. The location of the perforation was not found to be a factor indicative of failure. Conclusions: The success rate of HAFGM is superior to that of FGM alone. Hyaluronic acid fat graft myringoplasty can be performed as an office-based procedure using local anesthesia and requires no hospitalization. Because of its substantial advantages, HAFGM could be considered as the first choice for the reconstruction of a dry TMP in the pediatric population.