Various graft materials have been used to close tympanic membrane perforations. The commonly used being temporalis fascia. Among the other graft materials used Fat fits the billing appropriately. Ringenberg was the first to use fat tissue to seal ear drum perforations.
Advantages of using fat graft:
The surgical procedure is rather simple. It can be inserted through the perforation after freshening the edges. Fat tissue available in the lobule of the ear can be utilized for this purpose. It is really wonderful to use fat to seal small perforations of ear drum.
Fat from ear lobe is considered to be better than that present in the abdomen / buttock area by Ringenberg as it is more dense and exhibits better scafolding for epithelial and mucosal overgrowth over the perforation.
Fat plugging does not require support at the level of anterior annulus which is actually a bane in conventional temporalis fascia myringoplasty.
Fat is actually a highly active material which could promote scarring and revascularization of adjcent areas.