Surgical Outcomes of Collagen Patch Versus Fat Plug in the Repair of Tympanic Membrane Perforations: A Prospective Study

Small perforations of the tympanic membrane (TM) remain a common concern in otology, with potential consequences such as recurrent infections, conductive hearing loss, and cholesteatoma formation if left untreated. Conventional grafting materials like temporalis fascia are widely accepted, but minimally invasive office-based alternative, including collagen patch and fat plug, are increasingly recognized for their efficacy and patient convenience. This prospective study was conducted at Sree Balaji Medical College and Hospital, Chrompet, Chennai, and included 46 patients aged 20-50 years with small central TM perforations. Participants were randomly assigned to undergo either collagen patch myringoplasty or fat plug myringoplasty, and outcomes were evaluated through otoscopic examinations and audiometric assessments at baseline and at one month and two months postoperatively. Both techniques demonstrated significant postoperative improvement in air-bone gap (p<0.0001). At two months, complete closure was achieved in 91.3% of patients in the fat plug group compared to 78.3% in the collagen patch group. Fat plug myringoplasty showed fewer failures, particularly in cases with traumatic and post-myringoplasty perforations, whereas infection and otomycosis during the healing phase were the primary causes of graft failure in both groups. While early healing rates were comparable, fat plug myringoplasty demonstrated slightly superior long-term outcomes. These findings suggest that both collagen patch and fat plug myringoplasty are effective, minimally invasive options for repairing small TM perforations. However, fat plug myringoplasty appears to offer higher closure rates and greater reliability in complex etiologies, supporting its value as a practical alternative in office-based otologic surgery.