Developing a novel meatal areolar tissue autograft for minimally invasive tympanoplasty

Abstract

Background: We developed an easy and minimally invasive method of transmeatal tympanoplasty using meatal areolar tissue (MAT) grafts to achieve less postoperative morbidity or surgical scarring. We compared the functional and anatomical results of the developed method with conventional endaural tympanoplasty with a temporalis fascia (TF) graft.

Methods: In this retrospective cohort study, 58 patients (59 ears) with simple chronic otitis media who underwent type I tympanoplasty between January 2016 and August 2018 were included. All surgeries were performed in a tertiary referral hospital and by the same senior surgeon. The tympanic membrane (TM) was repaired with either a TF or an MAT graft.

Results: Healing of the perforated TM and improvement in a hearing test by air-bone gap (ABG) closure were identified. Postoperative wound conditions were also evaluated. Twenty-eight ears were grafted with MAT, and 31 ears were grafted with TF. Graft success was observed in 26 patients (92.9%) in the MAT group and 28 patients (90.3%) in the TF group. Both groups showed functional improvement compared with the preoperative measurements. The postoperative pure tone audiogram (p = 0.737), ABG closure (p = 0.547), and graft success rate (p = 0.726) were not significantly different between the two groups. Neither wound dehiscence nor keloid formation was observed in our patients.

Conclusion: Both MAT and TF grafts revealed satisfactory surgical and functional results. Compared with the conventional endaural approach with TF grafts, the new transmeatal approach method with an MAT graft causes relatively minimal trauma and results in better wound cosmetics. This method represents an easy, minimally invasive surgery and shows comparatively good results.

Fig. 1.

Harvesting the meatal areolar tissue (MAT) graft during the surgery. (A) A linear incision is made over the inner surface of the external ear canal. (B) The underlying soft tissue beneath the skin. (C) The areolar tissue can be fully visualized using a mastoid retractor. (D) The MAT graft is separated from the adjacent tissue. (E) The remaining meatal skin after harvesting the areolar tissue graft. (F) The graft is trimmed to a customized size and thickness. The yellow arrow indicates the meatal skin, and the star indicates the intrameatal graft.

Fig. 2.

Histomorphology of the meatal areolar tissue (MAT) (A) and temporalis fascia (TF) (B) grafts. Collagen fibers can be seen in both grafts, while glandular tissues are rich in MAT. The star indicates ceruminous glands, and the arrow indicates collagen fibers.

Fig. 3.

Preoperative and postoperative pictures. (A) Two weeks after the surgery. There is no external skin wound. (B) Two weeks after the traditional surgery. Note the scar between the tragus and helix. (C) Endoscopic view before the surgery and (D) 3 months after the surgery. Note the neovascularization of the meatal areolar tissue (MAT) graft and the well-pneumatized middle ear.