Investigation of Novel Grafts in Use for Pediatric Tympanoplasty

Abstract

Objectives: To evaluate the impact of allograft and xenograft in pediatric tympanoplasty on patient outcomes. Methods: A retrospective cohort study of 50 pediatric patients undergoing tympanoplasty at a single tertiary pediatric hospital system that received either autograft, allograft, or xenograft. Patients were evaluated for persistent perforation, recurrent perforation, revision surgery, and postoperative infection. Hearing outcomes, operative charges, and operative time were also evaluated. Statistical analyses included chi-square and Fisher exact tests for categorical data and Wilcoxon-Mann-Whitney tests for continuous data. Results: Half of the cohort received autografts, whereas 38% received xenografts and 14% received allografts. Although there was not a significant difference in charges associated with these procedures, xenografts had the shortest mean operative time (mean: 39 vs 68 minutes in autografts, p = .05). Overall, the rate of persistent perforation was 10%, recurrent perforation was 20%, revision surgery was 16%, and postoperative infection was 18%. There were no differences in the rates of these outcomes by graft type. Furthermore, there was no observed difference in hearing outcomes among autograft and xenograft recipients, but allograft recipients had significantly improved hearing postoperatively. Conclusions: Similar rates of complications were observed among autografts, xenografts, and allografts, providing preliminary evidence that they are safe to use in pediatric tympanoplasty.

Negative Outcome of Temporalis Fascia Graft in Tympanoplasty with Excessive Bleeding: A Retrospective Study

“…Performing the uni- and multivariate analysis of outcome, we determined that large TM perforations and moderate-to-severe intraoperative bleeding were independent prognostic factors of postoperative TM perforations. Graft type was not associated with the outcome, as reported by other studies that compared xenograft with autologous materials [ 9 , 19 ]. In our patients, large perforation (three or all quadrants) was associated with negative outcome.…”

Pediatric Primary Tympanoplasty Outcomes With Autologous and Non-autologous Grafts

“…The published rates of successful closure of pediatric TM perforations range from 55 to 96% (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Two recent meta-analyses calculated identical average closure rates of 83.4% for pediatric tympanoplasty and myringoplasty, which is higher than this study's success rate of 79.6% (31,32).…”

“…D’Eredita performed a randomized controlled trial (RCT) of 404 pediatric patients comparing porcine submucosa and temporalis fascia, in which the rates of success were not significantly different (15). A small retrospective study in children also found no difference in success rates between fascia, human pericardium, and porcine submucosa (19). Surgeons at our institution have used a mixture of autologous and non-autologous tissues in pediatric tympanoplasty over the past 20 years, offering an opportunity for diverse comparison in a larger cohort.…”

Prospective Comparison of Pediatric Endoscopic Lateral Graft and Interlay Tympanoplasty

“…To add to these developments, the availability of nonautogenous grafts, such as porcine-derived collagen (PDC) grafts, provides a benefit to pediatric patients undergoing repair of tympanic membrane perforations (9,11,12). The surgeon's ability to size and shape the PDC graft overcomes the problem of inadequate native graft tissue in smaller children with large perforations (5,8).…”

“…The surgeon's ability to size and shape the PDC graft overcomes the problem of inadequate native graft tissue in smaller children with large perforations (5,8). PDC graft demonstrates closure rates comparable to temporalis muscle fascia (TMF) with microscopeguided surgery and TEES (5,13), is associated with shorter operative times (14) and reduced postoperative morbidity (11,14,15), and saves the graft donor site for future operations (14,15).…”