Purpose: A retrospective clinical study for reporting the efficacy of fat grafting for small 
tympanic membrane perforations due to: trauma, infection, post-tympanostomy tube 
extraction and post myringoplasty residual perforations with topical use of autologous platelet 
rich plasma (PRP). Patients and Methods: Thirty patients aged between 18 to 58 years; with 
fat graft myringoplasty were operated for closure of tympanic membrane perforation due to 
the above causes. Half the patients underwent fat graft myringoplasty (group A), while others 
received the fat graft with PRP (group B). Results: The graft was taken in 13 patients 
(86.7%) in group A, and in 14 patients (93.3%) in group B. Healing time was shorter in group 
B (2 months) than in group A (3 months). There was insignificant different between the two 
graft types in hearing gain, but in each graft type there was significant decrease in the mean 
ABG postoperatively. Conclusion: Fat graft myringoplasty is an easy, simple, fast and 
minimally invasive procedure for the repair of small tympanic membrane perforations with 
favorable results with topical autologous PRP.