277 The Journal of Laryngology & Otology April 2005, Vol. 119, pp. 277–279 Fat graft myringoplasty: a cost-effective but underused procedure O B OZGURSOY , MD, I YORULMAZ, MD Abstract Objectives: The objective of this study was to evaluate the success of fat graft myringoplasty and to discuss the utilities and advantages of a fat graft in primary versus revision myringoplasties. Methods: Eighteen patients who had not had previous otological surgery, and twelve patients whose tympanic membrane perforations have persisted despite myringoplasty with temporalis fascia were included in this prospective clinical trial. All patients were treated by fat graft myringoplasty and followed up for one year. Results: Successful closure of the perforation was obtained in 82.4 per cent of the ears at the final follow up. The success rate in the group of patients who had not had previous otological surgery was higher than those of revision cases. Conclusions: Adipose tissue provides the basic requirements for grafting of the tympanic membrane, with its own favourable characteristics. Fat graft myringoplasty is a cost-effective alternative in small perforations of the tympanic membrane, including revision cases. Key words: Myringoplasty; Adipose Tissue; Middle Ear; Surgical Procedures Introduction The ideal approach for closure of tympanic membrane perforations remains controversial. Although grafting of the perforation with temporalis fascia is the most frequent choice, 1–4 there have been several trials in which adipose graft was successfully used for small tympanic membrane perforations. 5–9 Adipose tissue has the advantage of being easily harvested in a short time with minimal donor site morbidity. 10 The success rates of fat graft myringoplasties were reported as comparable with the results of the procedures using temporalis fascia. 4–9 Fat graft myringoplasty is technically expedient and suitable to be carried out on a day case or out-patient basis, with limited post-operative care. The procedure avoids invasive surgical manipulations to the middle ear and does not require general anaesthesia or endolaryngeal intubation. 4 Furthermore, Gross et al. stated that fat graft myringoplasty does not cause significant otological trauma and used this safe technique to repair small tympanic membrane perforations of patients who had previous extensive otological procedure in the opposite ear. 8 Since myringoplasty with fat graft is a simple, safe and noncomplicated technique yielding satisfactory success rates, it allows for bilateral simultaneous repair of tympanic membrane perforations. 5 However, the literature yields little information about this cost-effective technique, and revision myringoplasty using fat graft has not been reported. The purpose of this prospective clinical trial was to evaluate the success of the fat graft myringoplasty and to discuss the utilities and advantages of this underused procedure in two groups of patients, with and without previous attempts of tympanic membrane repair. Materials and methods Thirty consecutive patients with persistent tympanic membrane perforation who qualified for the criteria listed in Table I were included in this study. There were 16 females and 14 males with the age range of 16–42 years. All patients underwent fat graft myringoplasty between February 2002 and September 2003. Patient selection depended on medical history, microscopic examination of the ears and audiometric measurements (Table I). Tympanic membrane perforations larger than one quadrant were considered to be unfavourable for insertion of the fat plug, and low hearing thresholds were accepted as indicators of ossicular pathology. The patient population was subdivided into two groups; the first group consisted of 20 ears of 18 patients who From the Department of Otorhinolaryngology-Head and Neck Surgery, University of Ankara,Turkey. Accepted for publication: 30 January 2005.