Hyaluronic acid fat graft myringoplasty: an office-based technique adapted to children.

摘要

OBJECTIVES: To evaluate hyaluronic acid fat graft myringoplasty (HAFGM) for different tympanic membrane perforation (TMP) sizes and to compare its success rate with that of the underlay and overlay techniques. DESIGN: Prospective study. SETTING: Tertiary care pediatric center. PATIENTS: Two hundred eight children aged 4 to 16 years (mean age, 11.84 years) with TMPs. INTERVENTIONS: The HAFGM is a new technique for TMP repair in an outpatient pediatric population using local anesthesia. All the patients in groups 1 (underlay) and 2 (overlay) were operated on using general anesthesia, whereas group 3 (HAFGM) was operated on at the outpatient office using local anesthesia. MAIN OUTCOME MEASURES: Postoperative status of the eardrum, hearing improvement, and incidence of complications. RESULTS: Patients with TMP were divided into 3 groups: group 1 had 75 patients; group 2, 65; and group 3, 73. The global success rate was 87% in group 3, with no difference with the remaining 2 groups. Successful closure of different TMP sizes was the same for the 3 groups. Postoperatively, air-bone gap improvement was better for group 3. No bone conduction threshold worsening was noted. The mean duration of the operative procedure was 65, 74, and 18 minutes for groups 1, 2, and 3, respectively (P = .02). Mean postoperative follow-up was 20.7, 17.5, and 14.6 months for groups 1, 2, and 3, respectively. Identification of the anterior perforation rim is mandatory to perform HAFGM. CONCLUSIONS: The HAFGM did not require hospitalization for pediatric patients. It had the advantage of being feasible in children using local anesthesia. Its success rate was comparable with that of conventional techniques.