• Tympanoplasty;
  • myringoplasty;
  • hyaluronic acid;
  • fat graft;
  • overlay;
  • underlay;
  • perforation;
  • tympanic membrane;
  • ear drum;
  • Level of Evidence: 1b



Hyaluronic acid fat graft myringoplasty (HAFGM) is a new technique for tympanic membrane perforation (TMP) treatment. It is simple, inexpensive, and performed under local anesthesia at the outpatient office department. We aim to evaluate the HAFGM on different TMP sizes, to compare the success rate of HAFGM with the underlay and overlay techniques, and to assess the hearing improvement at one year postoperatively.

Study Design:

Prospective study.


Patients were divided into three groups depending on the patient's choice of technique: HAFGM (group I), underlay technique (group II), and overlay technique (group III). Perforations were classified into four grades. Postoperatively, the status of the eardrum, the improvement of hearing, and the incidence of complications were the main criteria for measuring outcome.


Distribution of TMP was 131, 63, and 52 in group I, II, and III, respectively. Global successful rate and successful closure of the grade I, II, III, and IV were the same for the three groups. Postoperatively, no worsening of bone conduction threshold was noted. Air-bone gap (ABG) was statistically similar for the three groups. No complications were noted for group I. The mean duration of the operative procedures was 16, 65, and 74 minutes for group I, II, and III, respectively (P = .02). The mean postoperative follow-up was 18.7, 20.6, and 15.5 months for groups I, II, and III, respectively.


HAFGM success rate is comparable to that of the underlay and overlay techniques. Furthermore, it requires no hospitalization and avoids the difficulty of overlay and underlay tympanoplasty.