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. 2021 Feb;131(2):392-400.
doi: 10.1002/lary.28914. Epub 2020 Jul 27.

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

Iman Ghanad  1   2 , Marc D Polanik  1   3   4 , Danielle R Trakimas  5 , Renata M Knoll  1 , Melissa Castillo-Bustamante  1 , Nicole L Black  1 , Elliott D Kozin  1   2 , Aaron K Remenschneider  1   2   3   4
Affiliations

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

Iman Ghanad et al. Laryngoscope. 2021 Feb.

Abstract

Objectives: Nonautologous graft materials may solve several dilemmas in tympanoplasty by obviating the need for graft harvest, facilitating consistent wound healing, and permitting graft placement in the clinical setting. Prior studies of nonautologous grafts in humans have shown variable outcomes. In this systematic review, we aim to 1) summarize clinical outcomes and 2) discuss limitations in the literature regarding nonautologous grafts for tympanoplasty in humans.

Methods: A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The study size, etiology and duration of perforation, type of nonautologous graft, and postoperative closure rate were assessed.

Results: The PRISMA approach yielded 61 articles, including 3,247 ears that met inclusion criteria. Studies evaluated nonautologous grafts including paper patch, gelatin sponge, growth factors, porcine small-intestinal submucosa, among others. Traumatic perforations (62.3%) were most commonly studied, whereas postinfectious perforations (31.9%) and other etiologies (5.8%) comprised a minority of cases. Acute perforations of <8 weeks duration constituted just over half of all treated ears. Overall closure rate was 82.1%, with significantly higher closure rates in acute (89.9%) versus chronic perforations (64.9%, P < .01), regardless of material. A median postoperative air-bone gap of 5.6 dB was found in the 23% of studies reporting this metric.

Conclusions: The majority of publications reviewing nonautologous materials in tympanoplasty evaluate acute or traumatic perforations, and few rigorously report hearing outcomes. Given available data, porcine submucosa and basic fibroblast growth factor may hold promise for chronic perforation closure. Future studies should report closure rates and hearing outcomes in perforations >8 weeks duration. Laryngoscope, 131:392-400, 2021.

Keywords: Tympanoplasty; synthetic graft; tympanic membrane.

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References

BIBLIOGRAPHY

    1. Boedts D, De Cock M, Andries L, Marquet J. A scanning electron-microscopic study of different tympanic grafts. Am J Otol 1990;11:274-277.
    1. House WF, Sheehy JL. Functional restoration in tympanoplasty. Arch Otolaryngol 1963;78:304-309.
    1. Kaylie DM, Gardner EK, Jackson CG. Revision chronic ear surgery. Otolaryngol Head Neck Surg 2006;134:443-450.
    1. Hardman J, Muzaffar J, Nankivell P, Coulson C. Tympanoplasty for chronic tympanic membrane perforation in children: systematic review and meta-analysis. Otol Neurotol 2015;36:796-804.
    1. Tan HE, Santa Maria PL, Eikelboom RH, Anandacoomaraswamy KS, Atlas MD. Type I tympanoplasty meta-analysis: a single variable analysis. Otol Neurotol 2016;37:838-846.

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