J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 1, January 2017, pages 30-34

Hyaluronic Acid Fat Graft Myringoplasty Versus Autologous Platelet Rich Plasma

Figure 1. After centrifugation blood was separated into three layers: the bottom layer consists of red blood cells, the middle layer contains platelet poor plasma (PRP), which is composed of platelets and white blood cells (WBCs), and the top layer contains platelet poor plasma (PPP).

Figure 2. Right ear operated with PRPM technique shows postero-superiorly retracted healed tympanic membrane at 6 months postoperatively with external auditory canal pearl of cholesteatoma (arrow).

Figure 3. Right ear operated with HAFGM technique shows the healed tympanic membrane at 12 months postoperatively. We can identify the corda tympani through the new ear drum.

**Table 1.** Demographic Data
Patients	HAFGM (N = 16)	PRP (N = 11)	P value
HAFGM: hyaluronic acid fat graft myringoplasty; PRPM: platelet rich plasma myringoplasty.
Gender			0.97
Male	7	4
Female	9	7
Age (years)	55.8	57	0.88
Side			0.67
Right	4	3
Left	12	6
Previous surgery	2	4	0.54
Results			< 0.001
Success	13	2
Failure	3	9
Postoperative complications	0	3 (1 myringitis, 2 cholesteatoma )	0.02

Table 1. Demographic Data

Patients

HAFGM (N = 16)

PRP (N = 11)

P value

HAFGM: hyaluronic acid fat graft myringoplasty; PRPM: platelet rich plasma myringoplasty.

Gender

0.97

Male

Female

Age (years)

55.8

0.88

Side

0.67

Right

Left

Previous surgery

0.54

Results

< 0.001

Success

Failure

Postoperative complications

3 (1 myringitis, 2 cholesteatoma )

0.02

**Table 2.** Success Rates According to the Size of Tympanic Membrane Perforation
Grade of perforation	Patients
HAFGM: hyaluronic acid fat graft myringoplasty; PRPM: platelet rich plasma myringoplasty; NA: not applicable.
I (< 25%)	Success	7	1	0.0002
	Failure	0	5
II (25-50%)	Success	3	0	NA
	Failure	1	2
III (50-75%)	Success	2	0	NA
	Failure	1	1
IV (≥ 75%)	Success	1	1	NA

Table 2. Success Rates According to the Size of Tympanic Membrane Perforation

Grade of perforation

Patients

Result

HAFGM (n = 16)

PRP (n = 9)

P value

HAFGM: hyaluronic acid fat graft myringoplasty; PRPM: platelet rich plasma myringoplasty; NA: not applicable.

I (< 25%)

Success

0.0002

Failure

II (25-50%)

Success

Failure

III (50-75%)

Success

Failure

IV (≥ 75%)

Success

**Table 3.** Audiometric Results
PTA = 500 + 1,000 + 2,000 + 3,000 + 4,000/4 dB HL	Pre-operatively	6 months postoperatively	12 months postoperatively	P value
PTA: pure tone average; BC: bone conduction; SDS: speech discrimination score; SD: standard deviation; NA: not applicable.
HAFGM	PTA	44.3	28	30.3	< 0.0001	< 0.0001
	BC	24.4	22	20.4	0.243	0.23
	SDS %	94.6	94.2	95	0.717	0.068
PRP	PTA	47	41.41	30 (N = 3)	0.93	N/A
	BC	30	31.18	28.6	0.94	N/A
	SDS %	86.9	84.8	90.6	0.386	N/A

Table 3. Audiometric Results

PTA = 500 + 1,000 + 2,000 + 3,000 + 4,000/4 dB HL

Pre-operatively

6 months postoperatively

12 months postoperatively

P value

6 months

12 months

PTA: pure tone average; BC: bone conduction; SDS: speech discrimination score; SD: standard deviation; NA: not applicable.

HAFGM

PTA

44.3

30.3

< 0.0001

24.4

20.4

0.243

0.23

SDS %

94.6

94.2

0.717

0.068

PRP

PTA

41.41

30 (N = 3)

0.93

N/A

31.18

28.6

0.94

N/A

SDS %

86.9

84.8

90.6

0.386

N/A

**Table 4.** Review Studies Show the Success Rates of HAFGM
Review studies	No. of patients	Sex	Age	Success rate
F: female; M: male.
Saliba, 2008 [4]	21	F = 13, M = 8	53.6 years	81%
Saliba and Froehlich, 2011 [5]	73	F = 30, M = 43	11.62 years	87%
Saliba and Woods, 2011 [7]	131	F = 86, M = 45	48 years	92.70%
Saliba et al, 2012 [6]	50	F = 15, M = 35	11.68 years	90%
Alzahrani and Saliba, 2015 [15]	10	F = 4, M = 6	49 years	80%
Gun et al, 2016 [16]	31	F = 16, M = 15	25 years	87.10%

Table 4. Review Studies Show the Success Rates of HAFGM

Review studies

No. of patients

Sex

Age

Success rate

F: female; M: male.

Saliba, 2008 [4]

F = 13, M = 8

53.6 years

81%

Saliba and Froehlich, 2011 [5]

F = 30, M = 43

11.62 years

87%

Saliba and Woods, 2011 [7]

131

F = 86, M = 45

48 years

92.70%

Saliba et al, 2012 [6]

F = 15, M = 35

11.68 years

90%

Alzahrani and Saliba, 2015 [15]

F = 4, M = 6

49 years

80%

Gun et al, 2016 [16]

F = 16, M = 15

25 years

87.10%