Application of allogenous dural membrane (brefotissue DM) in surgical treatment of retraction pockets of the tympanic membrane

Abstract

The tactics of treating patients with retraction pockets of the tympanic membrane is still debatable. When choosing surgical treatment, preference is given to the removal of the retraction pocket with simultaneous reconstruction of the posterior-upper wall of the external auditory canal (retraction area) with a cartilage or fascial flap, autologous bone, or a combination of the above tissues. Considering the well-known negative aspects of the use of all the mentioned grafts, there is a need to find new types of tissues to strengthen the retraction pocket. For example, dura mater brefotissue has good plastic properties, resistance to infection, is easy to prepare, store, and is cheaper than many allografts. Evaluation of the possibility of using dura mater brefotissue in the surgical treatment of patients with retraction pockets of the tympanic membrane. The study included 52 patients who underwent surgery to eliminate the retraction pocket. All of them were divided into 2 groups. In the first - the main (n=25) cartilage of the auricle was used to seal the relaxed part of the tympanic membrane, in the second - the control (n=27) applied tissue of the dura mater. After 1, 3, 6 and 12 months, to assess the result of the intervention, all patients underwent otomicroscopy, audiometry with the calculation of the average sound conduction index for speech frequencies. Fewer cases (4 patients out of 27) had difficulty in graft placement with the use of dura mater compared to the group where cartilage was used (9 patients out of 25). The average duration of graft placement was 8±0.5 minutes in the control group and 2±0.3 minutes in the main group. A stable morphological result was obtained in the group with the use of brefotissue in 26 patients (96%) and only in 20 patients (80%) with the use of cartilage. It is important to note that in the group with the use of brefotissue, in the early postoperative period, there was an increase in the air-bone interval, and 1 month after the operation, the average values increased by 10±0.5 dB. 12 months after the operation, the above parameters returned to preoperative. The conducted study indicates that the dura mater brefotissue, having sufficient strength, the convenience of forming a given shape and placing it in the desired position, can be successfully used in the surgical treatment of patients with retraction pockets of the tympanic membrane.