Chemical Cauterisation versus Fat Plug Myringoplasty for Closure of Small Central Tympanic Membrane Perforation: A Prospective Interventional Study

Abstract

Introduction: Perforation of the tympanic membrane is a commonly encountered problem in otolaryngology and often leads to conductive hearing loss as well as recurrent middle ear infections. For smaller, central perforations, treatment has gradually shifted toward less invasive methods. Two such techniques chemical cauterisation and fat plug myringoplasty are widely practiced but rarely compared in a single study. This research was undertaken to explore and contrast these procedures in terms of healing success, auditory recovery, complication rates, and patient-reported outcomes. Aim: To compare the tympanic membrane closure rate with fat plug myringoplasty vs chemical cauterisation for treatment of small central perforations of pars tensa. Materials and Methods: The present prospective interventional study involved 60 patients presenting with small central tympanic membrane perforations. Conducted at a tertiary care hospital, participants were randomly assigned to one of two intervention arms. Group I received chemical cauterisation, while Group II underwent fat plug myringoplasty, with 30 individuals in each cohort. Hearing was evaluated using Pure Tone Audiometry (PTA) at baseline and repeated at three months postprocedure to assess postoperative improvement. Additional data on patient satisfaction and postoperative complications were also collected and analysed. Statistical analysis was performed using the Chi-square test for categorical variables and the independent samples t-test for comparing mean hearing improvement between groups. A p-value of <0.05 was considered statistically significant. Results: Among those treated with chemical cauterisation, 26 (86.7%) achieved complete closure of the perforation, compared to 28 (93.3%) in the fat plug group. Both interventions led to a meaningful improvement in hearing, with mean postoperative PTA was 16.21±1.26 dB in Group I and 17.62±1.67 dB in Group II. Minor postoperative issues were noted in both groups. Interestingly, satisfaction levels were higher in the fat plug group, with a mean score of 9.17±0.39 versus 8.50±0.50 in the cauterisation group. Conclusion: The findings suggest that while both techniques are effective and minimally invasive, fat plug myringoplasty may offer a slight advantage in terms of closure rates and patient satisfaction. These results support its consideration as a first-line option for the management of small central tympanic membrane perforations.

Keywords

• ear diseases
• fat tissue
• otologic surgical procedures
• patient satisfaction
• postoperative complications
• pure tone audiometry
• tympanic membrane perforation