One hundred twenty five fat myringoplasties: does marginal perforation matter?

Abstract

Objective

to evaluate if calcified plaques adjacent to the perforation and marginal perforations are real contraindications to the fat graft myringoplasty.

Study Design

prospective study.

Methods

This study was conducted, from 1^st January 2008 to 31 December 2015 at our Otolaryngology Department of S.G. Moscati Hospital. The investigation included 125 patients, 60 males and 65 females, affected by COM who have undergone fat graft myringoplasty between 01/01/2008 to 31/12/2011. The average age of patients was 46 years (ranged 18 – 80).The patients were selected consecutively. For all the procedures the last otomicroscopic control was performed in 2015. Follow-up studies were done at 3 days, 7 days, 1 month, 3 months, 6 months and then once a year(mean follow-up 5.5 years, range 4-7 years). Informed consent was obtained after discussion of the alternative solutions. The consent of our institutional ethic committee was obtained. The inclusion criteria were the following: none previously ear surgery, dry ear at the time of surgery, persistent perforation for at least 6 months, absence of granulomatous tissue and cholesteatoma, perforation size of up to 35% of the eardrum surface, absence of ossicular chain damage. All patients who met inclusion criteria were enrolled. All patients included in the study accepted to be controlled for the entire follow-up. On the basis of tympanic membrane characteristics the study group was divided into 3 groups and 4 sub-groups: Group A (n=67) the fat myringoplasty was performed following the traditional indications, Group B(n=31) marginal perforations in which one side of the perforation is the fibrous annulus, was divided in 2 sub-groups B1(n=16) without calcified plaques adjacent to perforation and B2 (n=15) with plaques, Group C (n=27), marginal perforations in which one side is the bone annulus, was divided in 2 subgroups C1(n=15) without plaques and C2 (n=12) with plaques. The Fisher exact test (FET) was used to compare results in the described groups(sub-groups B1 with group A, sub-groups B2 with group A, subgroups C1 with group A and subgroups C2 with group A). A p<0.05 was considered significant. The surgical success is obtained with a complete closure of the tympanic membrane perforation. 0 dB. The mean pre-operative air bone gap (ABG) was 18,2 dB. Calculation of hearing results was in accordance with the American Academy of Otolaryngology Head and Neck Surgery 1995 guidelines for reporting conductive hearing loss ⁷ .

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