Crossref DOI:10.21176/ ojolhns.0974-5262.2015.09.

TISSUE MYRINGOPLASTY :
A SIMPLE & COST EFFECTIVE TECHNIQUE
*Rupam Borgohain, **Swagata Khanna
ABSTRACT:
Introduction: Chronic suppurative otitis media is
a prevalent condition in country like India due to poor
socioeconomic conditions & lack of awareness. This
results in increased financial constraints & loss of
work days. CSOM may follow a benign course
causing great morbidity to the patient.

Vol.-9, Issue-I, Jan-June - 2015

Objective: The aim of this study is to determine

the efficacy of Fat plug or Tissue myringoplasty
(T.M.P.) which is a simple and cost effective technique.

INTRODUCTION:
Due to chronicity of the disease and lack of
absolute surgical technique, CSOM is still a
troublesome pathology.This is a disease of children
and adult alike. Perforation of tympanic membrane
is a challenge to this fraternity. Permanent cure of
this condition is essential to prevent repeated
infection which is attained by closing the perforation

Material & Methods: The study was undertaken

on patients who have attended the ENT OPD from
January 2005 to December 2013. A total of 203
cases with simple tympanic membrane perforation,
underwent T.M.P. operation.

Person with an aural discharge is restricted from

Discussion: In the present study, a total of 203

patients were studied in terms of graft material used
for operation as well as size of perforation
(microperforation comprising 25% of par tensa). The
Success Rate Achieved Was 84.23%.

have been developed for surgical closure of ruptured

Conclusion: This technique is found to be

effective for closure of smaller perforation involving
lesser morbidity and cost. Iatrogenic trauma were
negligible. It is easy, quick, minimally invasive, can
be done as OPD procedure and an effective way in
tackling microperforation following a conventional
myringoplasty and perforations following trauma.

part of surgeon. Even with proper skill and technique

Keyword: Chronic suppurative otitis media, Fat plug /

Tissue myringoplasty.

perforation which involve 25% of pars tensa. This

Address for Correspondence:

Dr. Rupam Borgohain, Assistant Professor
Gauhati Medical College And Hospital,
Guwahati, Assam.
E-mail: mailrupam70@gmail.com
Cell : +91 9435030540

aquatic activities and it is also a social stigma.

Due to morbidity, surgical closure is essential.
Various techniques of plastic repair i.e. myringoplasty

tympanic membrane. Myringoplasty is reserved for

simple repair without any reconstructive procedure of
the ossicular chain. Myringoplasty involves skill on the

rejection might occur due to virulence of the bacteria or

Eustachian tube anomaly.

A newer technique was deviced to tackle

tympanic

membrane

perforation

with

technique is simple, requires lesser skill, less

hospital stay and medical expenditures.
Microperforation

following

tympanoplasty

or

tympanic membrane perforation due to trauma or CSOM

are repaired with fat graft. It can be performed as OPD
procedure and is less time consuming. Adipose

18

small

*Assistant Professor, **Prof. & H.O.D. of E.N.T., Gauhati Medical College & Hospital, Guwahati, Assam

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

tissue is usually harvested from ear lobule or from the

abdomen. Microscopic comparison of the fat shows
that fat cells of the ear lobule were found to be more

complete
ENT
examination
was
done.
Audiological
evaluation
and
microscopic
examination was done in every case.

compact and contain more fibrous tissue. It provides

Predisposing factors like sinusitis, deviated nasal

scaffolding for the growth of tympanic membrane

epithelium and mucous membrane by bridging the gap.

conservative

AIMS AND OBJECTIVES:

The aim of this study is to find out the

success rate of this procedure in terms of
graft uptake and hearing improvement.

Selection criteria:
1.

A small central perforation the size being no

more than 25% of tympanic membrane by
otoscopic evaluation.

Wulstein & Zoellner (1951): Popularized

Myringoplasty technique with improved optics
and microsurgery. Various graft material has
been used since this time are skin, amniotic
membrane, mucous membrane, dura mater,
cornea, periosteum, perichondrium, vein,
adipose tissue and finally temporalis fascia.

2.

At least dry for 68 weeks preoperatively.

3.

Air bone gap better than 25 dB on operation side.

4.

No major Eustachian tube dysfunction problem.

Ringenberg (1962): Successfully used

adipose tissue ( fat ) to repair small tympanic

local anaesthesia. The ear lobe was also infiltrated in

membrane perforation.
3.

surgical

mastoid and chest were also included. Aural

culture to identify the organism was also done in
cases where necessary:

Myringoplasty is a known operation to all ENT

surgeons.

2.

required

The aim of this procedure is to deliver dry and sugar were done. Radiological examination of PNS,

REVIEW OF LITERATURE:

1.

and

intervention. Necessary blood examination for Hb%,

safe ear to the patient.

treatment

The ears were prepared with standard antiseptic

precaution. Commercially available 2% xylocaine with
adrenaline 1 in 200,000 infiltration was used to achieve

the posterior aspect. The margin of the perforation was

deepithelized circumferentially (Schematic Diagram

Mitchell et al (1997): Used fat in 342 children

to close small tympanic membrane
5

perforation achieving 92% success rate.

MATERIALS AND METHOD:

The study was undertaken on patients who

have attended the ENT OPD from January 2005
to December 2013. A total of 203 cases with
simple
tympanic
membrane
perforation,
underwent T.M.P. operation.

I). A fat plug was harvested from the ear lobule ( Pic 1
& 2 ) The size of the graft is about 2 times the size of
the perforation.
The fat plug was inserted into the perforation
resembling a DUMB BELL (Schematic DiagramII & III).
The graft was supported with tiny gel foam pledges
soaked in antibiotic solution. The graft was covered with
gel foam sponge soaked with antibiotic preparation till the
middle part of external auditory canal. Later, a ribbon
pack soaked in antibiotic skin ointment was used to

A thorough clinical history was recorded and a

obliterate the remaining part of the canal.

19

Vol.-9, Issue-I, Jan-June - 2015

septum, tonsillitis were taken care by preoperative

DOI No.: 10.21176/ ojolhns.0974-5262.2015.09.1

All the patients were followed up at 6 weeks,

3 months and 9 months.
RESULTS AND OBSERVATION:
A total of 203 patients were included in the study
during 9 years period (January 2005 to December
2013). All the cases had dry ear for 3 months prior to
Pic 1 &2 shows harvesting of fat from lobule

operation and pathologies of sinuses and throat were

managed accordingly during this period.

They belonged to age group between 16 years

and 48 years. We have encountered 147 males
(72.41%) and 56 female (27.58%) cases 77
(37.93%) patients belonged to middle economic
class and 126 (62.06%) to poor economic class. 126
patients (62.06%) were from rural background and
77 (37.93%) from urban background.
Of 203 cases, 17 (8.37%) cases had bilateral
perforation and had undergone tissue myringoplasty
Schematic Diagram-I

Schematic Diagram-II

Refreshing of the margin of the Gel foam sponge in the middle

perforation

ear cavity

in the same sitting. Adequate fat was collected from

one lobule. 77 (37.93%) had perforation on right
side and 109 (53.69%) on left side

All the cases presented with conductive

hearing loss. 128 cases had mild conductive loss
and 75 had moderate loss.

Vol.-9, Issue-I, Jan-June - 2015

All the cases gave history suggestive of

infection in the past. None gave history of trauma.

SCHEMATIC DIAGRAMIII
FAT PLUG INSERTED
INTO THE PERFORATION

SCHEMATIC DIAGRAMIV

FOLLOW-UP PICTURE (3
MONTHS) SHOWS GRAFT
BEING TAKENUP

19 cases who underwent myringoplasty

earlier but had microperforation on follow up were
taken up. All these 19 cases had intact tympanic
membrane during subsequent checkups.
32 (15.76%) patients had persistent perforation at
3 months after operation and the remaining 171 (84.23%)
cases had intact tympanic membrane. The success rate

Patients were discharged with advice to

prevent nose blowing, straining or any other
vigorous exercise. The pack was removed after 10
days and patient advised to apply topical ear drop.

was 84.23%. The average gain in hearing was 5 dB.

DISCUSSION:
In the present study, a total of 203 patients were
studied in terms of graft material used for operation as

well as size of perforation (microperforation

comprising 25% of par tensa).

T
h
e1.

Deddens

et

myringoplasty

S
u
c
2.
c
e
s
s

DOI No.: 10.21176/ ojolhns.09745262.2015.09.1

a close resemblance to:

al
as

(1993)
a

described

simple

cost

adipose
effective

technique. Success rate in their study was 89%.

closure was achieved in 349 i,e. 92%.

Rfor closure of smaller perforation involving lesser morbidity

a
and cost. Iatrogenic trauma were negligible.
t
eCONCLUSION:
Fat plug is an under used technique to repair
a small central perforation.

Fat is readily available from ear lobule and

abdomen.

Fat cells from ear were found to be more

compact and contain more fibrous tissue.

W
a
s
8
4
.
2
3
%
T
h
e
a
b
o
v
e
r
e
s
u
l
t
s
b
e
a
r

As there is no disturbance to middle ear

structures, there is a negligible risk of any
iatrogenic otological trauma making this
procedure very safe even for bilateral repairs.

in

tackling

microperforation

following a conventional myringoplasty and

perforations following trauma.

DISCLOSURES
(a) Competing interests/Interests of ConflictNone
(b) Sponsorships - None
(c) Funding - None
REFERENCES:
1.

Chalishazar U. Fat plug myringoplasty.

Indian J Otolaryngol Head Neck Surg
Neck Surg 2005;57:43-44

2.

Deddens AE, Muntaz HR, Lusk RP.

Adipose myringoplasty in children.
Laryngoscope 1993;103:216-9.

3.

Gold SR, Chaffoo RA. Fat myringoplasty

in the Guinea Pig. Laryngoscope
1991;101:1-5.

4.

Gross C, Bassila M, Lazar RH, et al.

It is easy, quick and cost effective way with

1,3,4
minimal morbidity.
It can be done as OPD procedure.

This technique is also found to be very

effective

Mitchell et al (1996) presented a study in 370

children over a period of 6 years. Successful

To sum up, this technique is found to be an effective

A
c
h
i

e
v
e
d

Adipose plug myringoplasty: An alternative

to formal myringoplasty techniques in
children. Otolaryngol Head Neck Surg
1989;101:617-20.

5.

Mitchell RB, Pereira KD, Lazar RH. Fat

graft myringoplasty in children - A safe
and successful day-stay procedure. J
Laryngol Otol 1997;111:106-8.

6.

Ringenberg J. Closure of tympanic

membrane perforation by the use of fat.
Laryngoscope 1978;88:982-93.

20