A Study of Comparison of Outcomes of Fat Myringoplasty and Chemical Cauterization for Closure of Small Central Tympanic Membrane Perforation

Background: Small dry central tympanic membrane (TM) perforations are commonly encountered in clinical practice and can lead to recurrent ear discharge and conductive hearing loss. For selected small central perforations, minimally invasive options such as fat plug myringoplasty and chemical cauterization are used to achieve closure, but their relative effectiveness varies across settings. Objectives: To compare the anatomical closure rate and post-procedure hearing status following fat plug myringoplasty versus 10% trichloroacetic acid (TCA) chemical cauterization for closure of small central dry TM perforations. Methods: This prospective comparative study was conducted in the Department of Otorhinolaryngology, from October 2020 to July 2022. A total of 50 patients aged >10 years with small central dry TM perforation (dry for ≥4 weeks) were included and randomly divided into two groups: Group A (n=25) underwent fat plug myringoplasty using ear-lobule fat. Group B (n=25) underwent 10% TCA chemical cauterization of the perforation margin repeated weekly for 5 weeks. Patients were followed up for 3 months, and perforation closure at 3 months was assessed. Hearing status was evaluated using pure tone audiometry and categorized for analysis. Data were entered in MS Excel and analysed using SPSS (chi-square test; p<0.05 considered significant). Results: The mean age of participants was 38.20 ± 14.4 years and 60% (n=30) were female. At 3 months, TM closure was achieved in 23/25 (92%) patients in the fat myringoplasty group compared with 16/25 (64%) in the chemical cauterization group (p=0.0168). A post-operative hearing category of <26 dB was observed in 23/25 (92%) patients after fat myringoplasty versus 16/25 (64%) after chemical cauterization (p=0.0168). Conclusion: For small central dry TM perforations, fat plug myringoplasty achieved a significantly higher closure rate than 10% TCA chemical cauterization at 3-month follow-up, with a more favourable post-operative hearing category distribution.