Success Rate of Fat Graft Myringoplasty
Fat graft myringoplasty achieves an overall success rate of approximately 82-92% for closing tympanic membrane perforations, with the highest success rates (85-91%) observed in perforations smaller than 30% of the tympanic membrane. 1, 2, 3
Overall Success Rates
The procedure demonstrates consistently high closure rates across multiple studies:
- 91.5% success rate in a large prospective series of 142 ears with variable perforation sizes 3
- 85.4% success rate in a retrospective study of 183 ears 1
- 85.4% success rate in a prospective cohort of 82 patients 2
- 82.4% success rate in a mixed population including revision cases 4
- 100% success rate reported when using umbilical fat in pediatric patients (28 cases) 5
Impact of Perforation Size
Perforation size significantly affects success rates, with smaller perforations achieving better outcomes:
- Perforations ≤30% of tympanic membrane: 86.4% success rate 1
- Perforations >30% of tympanic membrane: 79.1% success rate 1
- Perforations <30% of pars tensa: Highest success rates, with significant decrease when exceeding this threshold 2
The procedure remains effective even for medium-large perforations, though audiological outcomes are superior in smaller perforations 1
Impact of Perforation Location
Anterior perforation location does not significantly reduce success rates, contrary to traditional surgical concerns:
- Anteriorly located perforations: 85.2% closure rate 1
- Non-anterior perforations: 84.5% closure rate 1
- Anterior location is not a favorable prognostic factor but does not contraindicate the procedure 2
Audiological Outcomes
Hearing improvement accompanies successful closure in the majority of cases:
- Mean air conduction threshold improvement of 9.3 dB in successfully closed perforations 2
- Preoperative air conduction threshold of 59.3 dB improved to 35.6 dB postoperatively (P < 0.0004) 3
- Air-bone gap reduced from 30.2 dB to 10.2 dB postoperatively (P < 0.0001) 3
- Patients with smaller perforations achieve significantly better audiological outcomes than those with medium-large perforations (P < 0.05) 1
Clinical Considerations
Key factors that do not negatively impact success:
- Myringosclerosis presence: Does not correlate with reduced success rates and should not be considered a contraindication 2
- Bilateral procedures: Can be performed sequentially with maintained success rates 3
- Pediatric patients: Procedure is well-tolerated with excellent results comparable to adults 3
Factors associated with lower success rates:
- Revision cases: Primary myringoplasty cases show higher success rates than revision procedures after failed temporalis fascia grafts 4
- Perforations exceeding 30% of tympanic membrane: Success rate decreases but remains acceptable at approximately 79% 1, 2
Procedural Advantages
The technique offers several practical benefits that contribute to its effectiveness:
- Can be performed under local anesthesia in an office setting 2, 3
- Cost-effective alternative to formal tympanoplasty 4
- Fat can be harvested from ear lobe, post-auricular tissue, or umbilical tissue 5, 4
- Minimal anesthesia risk compared to general anesthesia (approximately 1:50,000 for ambulatory surgery) 6