Collagen Allografts Compared With Autologous Tissue in Tympanoplasty

Abstract

Objective: There are no direct comparisons between the success of collagen allografts versus traditional autografts for tympanic membrane (TM) repair. We sought to compare success rates in a large series of patients undergoing tympanoplasty using collagen allografts versus autologous tissues. Study Design: Retrospective review. Setting: Academic medical center. Subjects and Methods: Single institution retrospective chart review was performed for adult subjects with TM perforation undergoing tympanoplasty. Demographic, clinical, and surgical data were collected. Statistical analysis was completed using Rstudio. Each factor was examined to assess effect on graft success rate using logistic regression. Results: Two hundred sixty-five surgeries met criteria with four main grafting materials or combinations thereof. The overall graft success rate was 81.1% with failure rate of 18.9%. There was no significant association between failure rates and: age, sex, perforation cause, size, and location, primary or revision status, middle ear status (wet or dry), concomitant procedures (mastoidectomy or ossiculoplasty), presence of active cholesteatoma, or surgical technique. Although not statistically significant, the odds of success for perichondrium + cartilage were 7.5 times higher than collagen allografts (p = 0.07, 95% confidence interval [CI] = 0.81–69.6). The odds of success for the postauricular (odds ratio [OR] = 6.4) and transcanal approaches (OR = 24.8) were significantly greater than for endaural (p = 0.007 and p = 0.008, respectively). Conclusion: In tympanoplasty surgeries performed on patients with TM perforation, we found no statistically significant difference in graft failure rates between collagen allograft and other grafting materials or combinations, though the higher odds ratio of success with cartilage + perichondrium may be clinically relevant.

Tissue engineering and regenerative medicine strategies for the repair of tympanic membrane perforations

“…With an analysis of 255 patients, there were no statistically significant differences in the failure rate between collagen allografts and the analysed autologous tissues. Nevertheless, even not significantly, the chances of success of cartilage and perichondrium were 7.5 times higher than of collagen allografts [22] . Particularly, acellular dermis allograft is commonly used in the field.…”

Tympanoplasty in the Setting of Complex Middle Ear Pathology: A Systematic Review

“…A single study found perforation location to be predictive of anatomic failure. 8 The remaining studies showed that perforation location did not significantly impact anatomic 10,26,29,30,[32][33][34][35][36][37][38][39][40][41][42][43] or functional 10,29,34,44 success.…”

“…A single study claimed that the presence of cholesteatoma predicted anatomic failure; however, a statistical analysis supporting this claim was not presented. 45 Just 2 other studies analyzed the impact of presence of cholesteatoma on anatomic success and did not find it to predict failure compared to other causes of perforation 43 or other types of chronic ear inflammation. 46 Fifteen studies provided hearing outcomes for cholesteatoma cases.…”

“…One study found that cholesteatoma predicted anatomic failure 45 while 2 others did not. 43,46 Investigation of the role of cholesteatoma on functional success showed similarly mixed results. 9,28,[46][47][48][49] Six studies reported using 5 different graft techniques.…”

Tympanoplasty Before Tympanoplasty: Alea Jacta Erat!

“…It has become the standard procedure for repairing a tympanic membrane (2), and represents one of the first surgical procedures an otologic surgeon learns (3). As its basic principles still remain the same since its first introduction, many publications usually explain, in the introduction, that tympanoplasty has been a successful technique since Horst Ludwig Wu ¨llstein , a German otologist in Wu ¨rzburg, and Fritz Zo ¨llner (1901Zo ¨llner ( -1986, a German Austrian-born otologist in Freiburg, first proposed it in the 1950s (4,5), or sometimes more precisely in 1952 (6). Two English publications are generally mentioned as references, the 1955 Zo ¨llner paper (7), and the 1956 Wullstein paper (8).…”