Hyaluronic Acid Enriched Fat Graft versus Cartilage Perichondrium for Repair of Medium Size Tympanic Membrane Perforations

Background: Hyaluronic acid (HA) enriched fat graft myringoplasty (FGM) has many advantages compared with conventional MP using temporalis fascia and cartilage perichondrium, as it is short, easy, economical, and with minimum invasion and initiate a more rapid and complete healing process. This study aimed to evaluate the effectiveness of fat plug MP, enriched with HA for closure of medium size tympanic membrane perforations (TMP) (25-50% of TM surface area) and to compare it with classical cartilage perichondrium MP.

Methods: This prospective randomized control study was conducted on 50 cases with TMP. Cases were allocated into 2 groups: group I: tympanoplasty was done using fat graft enriched with HA. In group I hyaluronic was applied as gel foam soaked with commercially available HA and group II: tympanoplasty was done using cartilage perichondrium. All cases were subjected to ENT examination and pre-operative audiological evaluation including pure tone audiometry (PTA) and tympanometry.

Results: Graft taking was statistically insignificant after 3 months compared to 1 month follow ups in both groups. Air bone gap (ABG) was insignificantly different in the pre and postoperative ABG in both groups. Hearing was significantly improved postoperatively compared to preoperatively in both groups (P value<0.001). There was no significant difference in distribution of side of perforation in both groups. Hearing gain was statistically insignificant between both groups (P value=0.256). Hearing was significantly improved postoperatively compared to preoperatively in both groups (P value <0.001).

Conclusion: In cases with TMP, the TM HA enriched Fat graft myringoplasty (FGM) is an effective procedure with minimal invasion in management of the medium sized TMP. Also, it is safe and feasible procedure. Hearing was significantly improved postoperatively compared to preoperatively in both groups: HA enriched FGM group and MP with cartilage perichondrium group respectively.