Fat Myringoplasty Outcome Analysis With Otoendoscopy: Who is the Suitable Patient?

Objective: This study evaluates the success of fat graft myringoplasty under local anesthesia in relation to the size and location of the perforation and the presence of myringosclerosis using otoendoscopy findings. Study Design: Prospective cohort study. Setting: Tertiary referral center. Materials and Methods: Eighty-two patients without history of previous ear surgery underwent a fat graft myringoplasty under local anesthesia and followed up for 6 months. The fat graft harvested from the ear lobe in all cases. Otoendoscopy was used to record preoperative perforation and postoperative course. Measurements on endoscopic findings performed with Adobe acrobat software. Factors assessed were perforation size, location and myringosclerosis preoperatively, and residual perforation and graft neoangiogenesis postoperatively. Pure tone audiogram preoperatively and postoperatively was performed. Results: Successful closure of the perforation was observed in 70 (85.36%) of 82 ears. The success rate significantly decreased when the size of perforation was more than 30% of the pars tensa. The anterior location was not a good prognostic factor for a successful procedure. Myringosclerosis did not correlate with the success rate of the procedure. Angiogenesis to the fat graft divided in 3 categories according to its origin: the handle of malleus, tympanic rim, and mixed with an equal distribution. The air conduction thresholds of 42 ears were slightly improved (mean, 9.3 dB), whereas the thresholds of 29 ears remained unchanged. Conclusion: A fat graft myringoplasty achieves its highest success rate in perforations smaller than 30% of the pars tensa. Tympanosclerosis should not be a contraindication for fat grafting.