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Cartilage versus the rest in Type I Tympanoplasty – who wins?

Presenting Author: Hsern Ern Tan

Published online by Cambridge University Press:  03 June 2016

Hsern Ern Tan
1. Sir Charles Gairdner Hospital, 2. Ear Science Institute of Australia
Peter Santa Maria
Sir Charles Gairdner Hospital
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Copyright © JLO (1984) Limited 2016 

Learning Objectives: To determine the efficacy of different graft materials in Type I tympanoplasty through systematic review.

Introduction: In Type I Tympanoplasty, the most commonly used graft materials are temporalis fascia, cartilage and fat, which are all readily accessible at the surgical site. Over the years many other natural and synthetic materials have been trialled, but there are few published studies on outcomes. There has been a renewed interest in cartilage grafting due to its rigidity and resistance to retraction.

Aims: To determine the efficacy of different graft materials in Type I tympanoplasty through systematic review.

Methods: Using a search of the MEDLINE and PubMed databases from 1970 to 2014, all RCTs and retrospective studies reporting the outcomes of Type I tympanoplasty in primary chronic tympanic membrane perforations were identified. The studies were then analysed in a single variable analysis to compare the success rate of tympanic perforation closure between four major graft materials (cartilage, fascia, fat and other).

Results: 214 studies were identified from a total of 4704 abstracts. Cartilage had the greatest success rate of the four groups with 90.80%, across 33 studies (1746 patients) compared to fascia with a success rate of 88.00%, across 121 studies (14806 patients) and significant p value of 0.048. Fat had a success rate of 86.52% (across 22 studies and 1507 patients) and the last category of ‘other’ had a success rate of 85.39% (across 36 studies, 4217 patients) but the difference was not significant.

Conclusions: Cartilage has a superior graft closure rate compared to fascia in Type I tympanoplasty. Though this is consistent with the findings in recent literature, cartilage is also often used as a graft material for smaller sized perforations, which innately have higher healing rates, and this may account for the increased closure rate with cartilage compared to other graft materials.