<p class="abstract"><strong>Background:</strong> To compare the efficacy between fat graft (FG) and temporalis fascia (TF) graft in tympanic membrane perforations larger than 4mm size or involvement of &gt;25% of tympanic membrane.</p><p class="abstract"><strong>Methods:</strong> This prospective study was carried out during December 2015 to January 2016, for a period of 13months at our Otolaryngology Department. All study patients, who fit into inclusion and exclusion criteria, were divided into two groups according to the type of graft material taken. In group- 1temporalis fascia (TF) graft was taken while in group- 2 fat graft (FG) was taken. An evaluation of hearing was done with full Audiometric and Eustaschian tube function testing. All laboratory preoperative testing was done. Postoperative follow up was done at 2^nd, 3^rd and 5^th month’s period and sos, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded and compared with preoperative PTA records in both groups.  </p><p class="abstract"><strong>Results:</strong> In TF group total 24 (80%) patients had graft uptake, 4 (13.3%) patients had residual perforation and 2 (6.6%) patients had graft failure due to postoperative infection. In FG group total 16 (53.3%) patients had graft uptake, 6 (20%) patients had graft medialised and necrosed, 6 (20%) patients had residual perforation and 2 (6.6%) patient had graft rejection due to postoperative infection. Graft uptake rate in group 1 was 80% while in group 2 was 53.3%. Mean preoperative ABG in TF group was 25±17 dB and mean postoperative ABG was 10±02 dB, in fat graft technique mean preoperative ABG was 25±13 dB and mean postoperative ABG was 16±15 dB. Fat graft technique is simple, quick and minimally invasive. It doesn’t require middle ear manipulation.</p><p><strong>Conclusions:</strong> There is no ideal material for tympanic membrane repair but for moderate to large perforation temporalis fascia graft is better than fat graft in terms of healing and hearing outcomes but considering morbidity fat gives less morbidity. </p>

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<p class="abstract"><strong>Background:</strong> In the present study, an attempt was made to study the effectiveness of fat graft material and the improvement in hearing following fat myringoplasty in small central perforations of pars tensa.</p><p class="abstract"><strong>Methods:</strong> This prospective study was carried out in our tertiary centre between October 2014 to October 2015 in 38 patients selected randomly who attended our ENT OPD. Patients with tubotympanic type of chronic suppurative otitis media CSOM (TT), with dry small central perforation involving less than 25% of tympanic membrane (TM) were included. Patients with ossicular fixation or disruption with air bone gap (ABG) &gt;40dB were excluded. All procedures were performed under local anesthesia (LA). Fat graft was harvested from ear lobule and was placed through endomeatal microscopic approach after freshening perforation margin. All patients were followed up to 5months postoperative period and graft status and audiological assessment was made.  </p><p class="abstract"><strong>Results:</strong> In 86.8% cases (33 patients) graft was taken up while in 13.2% cases (5 patients) graft was not taken up. Mean pre-operative air conduction in right/left ear was 28.5±7.6/27.1±8.5 and post-operative was 24.9±5.3/23.4±6.9 dB respectively. Similarly, it was seen that mean pre-operative air bone gap in right/left ear was 17.6±7.2/17.0±7.4 and post-operative was 14.0±5.3/13.2±6 dB respectively.</p><strong>Conclusions:</strong> It is a very safe, simpler procedure and in this we don’t disturb the annulus so the chance of lateralization or medialization of graft is nil. During fat myringoplasty the angle of tympanic membrane and anterior recess is maintained in natural position and we don’t disturb acoustics, so fat myringoplasty is an excellent option especially for small perforation.