Author(s)
Vibhav N. Prakasam, BS
Mark A. Vecchiotti, MD
Andrew R. Scott, MD
Affiliation(s)
Tufts University School of Medicine; Tufts Children's Hospital;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should have further insight on whether performing a patch myringoplasty to repair a perforated tympanic membrane is more effective for long term closure and other outcome measures compared to a fat graft myringoplasty.
Objectives: Tympanic membrane perforations can be repaired via myringoplasty with different surgical approaches. One method is to harvest an autologous fat graft from behind the earlobe to plug into the membrane. Another option is to patch it using a foreign material, such as paper, absorbable gelatin film (Gelfoam), or esterified hyaluronic acid (EpiDisc). This study seeks to determine if there is a difference in outcomes between patients who underwent fat graft myringoplasty and patients who underwent patch myringoplasty.
Study Design: This was a retrospective data review of pediatric cases of fat graft and patch myringoplasties performed by two pediatric otolaryngologists.
Methods: The database of an urban, pediatric otolaryngology practice was utilized to identify patients who underwent these procedures and to investigate followup data. Patients were stratified into demographics and outcome measures were determined.
Results: Between January 2011 and March 2020, 235 ears were repaired on 195 children who met inclusion criteria (n=65 fat, n=170 patch). The fat graft group was significantly older (mean age 7.49 years vs 5.41 years, p<0.01) with significantly less secondhand smoke exposure (n=2 vs n=20, p<0.05) and significantly less loss to followup (n=0 vs n=13, p=0.03). There were no other differences in demographics. Furthermore, there was no significant difference between groups in postoperative infection or permanent closure of the tympanic membrane.
Conclusions: Despite the greater smoke exposure, the patch myringoplasty group displayed no difference in outcome compared to the fat graft group. Perhaps with a larger fat graft sample size, a difference would be noted. Cost and other outcomes can also be further investigated.