Heterologous Materials Are Really Better than Autologous in Tympanoplasty Mastoid Obliteration? A Systematic Review with Meta-Analysis

Abstract

The aim is to analyze Literature concerning mastoid obliteration in adults with either autologous or heterologous grafts in the last 10 years. Data Source: Databases such as NIH PubMed, Bookshelf, NLM Catalog, Cochrane Library, and Embase were consulted. Thirty-seven studies were selected (22 concerning autologous materials, 15 about heterologous ones). Only studies with more than 12 months of follow-up were considered. A statistical analysis with random-effects models was performed to allow the true effect sizes to differ from study to study. The present literature review and meta-analysis does not allow to establish the supremacy of one technique over the other, but underlines the advantages of each reconstructive choice and the importance of mastoid obliteration in cholesteatoma surgery. The total number of obliterated ears was 2882. Overall otorrhea rate was 5% (5.2% for heterologous grafts; 4.9% for autologous materials; P < .05). Recurrent and residual cholesteatoma rate was 4.5% (3.4% in heterologous materials; 5.2% in autologous grafts; P < .05). Recurrent cholesteatoma rate was 1.8% (1.6% when using heterologous grafts, 1.9% with autologous; P < .05). Residual cholesteatoma rate was 1.5% (1.6% with heterologous materials, 1.5% with autologous; P < .05). TM (tympanic membrane) retraction pockets rate was 5.3% (3.6% with heterologous materials; P >.05; 7% with autologous materials; P < .05). TM perforations rate was 2.9% (4.3% with heterologous materials, 2.5% with autologous; P < .05). Infection rate was 2.3% (2.3% with heterologous materials, 2.2% with autologous; P < .05). Heterologous materials are associated with significantly lower rates of recurrent and residual cholesteatoma and retraction pockets development, although they are associated with higher rates of otorrhea and TM perforation.

Figure 1.

PRISMA 2020 flow diagram.

Figure 2.

Otorrhea (Forrest Plot). The overall rate of otorrhea was 5%; in mastoid cavities obliterated with heterologous materials the rate was 5.2% while in the ones obliterated with autologous grafts was 4.9%. Red line: Studies concerning autologous materials; Blue line: Heterologous materials; Green line: Overall rate observed in all the studies.

Figure 3.

Recurrent and Residual Cholesteatoma (Forrest Plot). Overall recurrence and residual rates were 4.5, 5.2% in surgeries performed with autologous materials and 3.4% in obliterative surgeries with heterologous materials. Red line: Studies concerning autologous materials; Blue line: Heterologous materials; Green line: Overall rate observed in all the studies.

Figure 4.

TM perforations (Forrest Plot). The overall rate of TM perforations was 2.9%, 2.5% for the ears obliterated with autologous materials, and 4.3% in those where heterologous materials were used. Red line: Studies concerning autologous materials; Blue line: Heterologous materials; Green line: Overall rate observed in all the studies.

Figure 5.

TM retraction pockets (Forrest Plot). The overall rate was 5.3%, 7% in surgeries performed with autologous materials, and 3.6% in obliterative surgeries with heterologous materials. Red line: Studies concerning autologous materials; Blue line: Heterologous materials; Green line: Overall rate observed in all the studies.