Abstract
BackgroundHuman-derived acellular dermal matrix (ADM) has been widely used as an effective alternative to autologous grafts in tympanoplasty. However, evidence of ADM as an alternative to autologous grafts in the repair of tympanic membrane (TM) perforation still lacks adequate empirical evidence.ObjectivesTo determine the clinical safety and efficacy of human-derived ADM as TM graft material for tympanoplasty.Data sourcesThe PubMed, EMBASE, Cochrane Library, EBSCO, Ovid, Scopus, and Web of Science databases and reference lists of the retrieved articles were searched, with no language restriction.Selection criteriaAll randomized controlled trials and retrospective cohort studies that compared the use of human-derived ADM and autologous grafts in tympanoplasty for TM perforation were included.Data collection and analysisTwo review authors independently assessed risk of bias in the included studies and extracted data. The pooled results for continuous data were reported as a mean difference (MD) and 95% confidence intervals (CI). For dichotomous data, odds risk (OR) with 95% CI was used. ChI2 statistic and Galbraith plots were used to assess the heterogeneity. Publication bias was assessed with a funnel plot and Egger’s test.Main resultsFive retrospective cohort studies and four randomized controlled studies with a total of 610 participants were included in the meta-analysis. No significant differences in graft success (OR: 0.71 [0.39, 1.29], p = 0.26), air-bone gap (ABG) reduction (MD: − 0.59 [− 3.81, 1.19], p = 0.51), or complications (OR: 1.23 [0.07, 20.64], p = 0.89) were found between the ADM group and autologous graft group. The use of ADM significantly shortened tympanoplasty surgery time (MD: − 16.14 [− 21.22, − 11.07], p < 0.00001) and reduced postoperative pain (MD: − 2.57 [− 3.57, − 1.58], p < 0.00001) compared with the autologous graft group.ConclusionHuman-derived ADM might be an effective alternative to autologous grafts for tympanoplasty. However, some of the studies that were included in the present meta-analysis had rather low methodological quality, and more adequately designed clinical trials should be performed in the future.Graphical abstract
Highlights
Human-derived acellular dermal matrix (ADM) has been widely used as an effective alternative to autologous grafts in tympanoplasty
Types of studies Randomized controlled trials and retrospective cohort studies that compared the use of ADM and autologous grafts in tympanoplasty for tympanic membrane (TM) perforations were included in the present meta-analysis
Two studies did not use autologous grafts as a control group [19, 21], and one study did not focus on TM perforation [20]
Summary
Human-derived acellular dermal matrix (ADM) has been widely used as an effective alternative to autologous grafts in tympanoplasty. Evidence of ADM as an alternative to autologous grafts in the repair of tympanic membrane (TM) perforation still lacks adequate empirical evidence. Tympanic membrane perforation is usually caused by trauma, chronic otitis media, or surgical complications and presents with conductive hearing loss [1]. Most TM perforations heal spontaneously, some patients require surgery [2]. Different types of graft materials have been used to reconstruct the TM, including temporalis fascia, cartilage perichondrium, adipose tissue, muscle fascia, and scar tissue [4–7]. The temporalis fascia and tragal perichondrium are the most commonly used graft materials, with a good success rate for TM reconstruction [8–11]. Additional incisions are required during surgery to harvest these materials, which increases patient suffering and the risk of postoperative infection
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
