Perforations of the ear drum membrane in children are not rare and can be a side effect of having had middle ear ventilation tube surgery. When a perforation persists either from infection or an ear tube or both, the question is how best to repair such with the least risk, the least anesthesia, and achieving a sufficiently high success rate. Fat grafts have been used for this purpose for many years but do not have uniformly high success rates. Use of micro-perforated hyaluronic acid sheeting has not been effective, either. This study combined the sheeting with the fat and compared the healing probability to just using a small piece of fat by itself. It was used for perforations of the ear drum membrane that occupied no more than 25% of the tympanic membrane surface. Postoperative hearing outcomes were compared, as well.

Ninety-two children with small tympanic membrane perforations were included in the study. Fifty were operated using either the sheeting combined with a small piece of fat and 42 were operated with the simpler, older fat placement technique. Age at surgery ranged from 4 to 17 years (mean age, 11.52 years).

Results: Successful closure of the ear drum membrane was achieved in 90% of the combined sheeting/fat graft group and in only 57% of the plain fat graft group. The postoperative hearing was understandably better in the combined fat-sheeting group as well. The probability of success did not depend on how old the children were at the time of surgery. No postoperative complications were observed. The locationof the perforation in the ear drum membrane was not found to be a factor indicative of failure.

Conclusions: The success rate of combining the hyaluronic acid sheeting with a small piece of fat was superior to the old technique of using fat alone. The Canadian authors suggested that this procedure could conceivably be done in a physician’s office.

Our comments: The clear need for sterility and safe sedation make this procedure best if done at an ambulatory surgery center or at a hospital. In addition, this procedure has a success rate of about 90% and is limited to small holes in the ear drum membrane compared to 97-98% succcess rates for larger perforations approached more invasively. In other words, this procedure takes minimal time by comparison as a trade offfor slightly lower success rates with the advantage of less potential for scarring and its effects on hearing. This procedure, then, has a place for small, relatively uncomplicated perforations in ear drummembranes.

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