Repair of the total tympanic membrane perforation: AlloDerm vs temporalis fascia

Abstract

Objectives: Patients who require surgery for chronic otitis media with perforation and cholesteatoma frequently have scarce residual tympanic membrane or cholesteatoma adherently involving its entire undersurface. These situations prove poor for standard underlay tympanoplasty techniques. A novel technique is described that maximizes healing and minimizes complications of mucosalization and anterior blunting. The results are compared using Alloderm vs temporalis fascia as grafting materials. Fascia is used when available in primary cases, while AlloDerm has proven successful in revision cases or when delayed epithelialization can be expected. Methods: A retrospective review was performed on all otologic cases at a tertiary care public hospital from 1999 to 2003. Fifty-five cases where total reconstruction was required were included in the study. Simple underlay grafting cases were excluded. Data reviewed included preoperative diagnosis, intraoperative findings, grafting material used, surgical technique, postoperative healing, complications. The group of patients who underwent reconstruction using fascia were compared to those who underwent AlloDerm reconstruction. Results: The 2 groups of patients were similar in preoperative diagnosis, intraoperative findings, surgical technique, and postoperative healing. The AlloDerm group had a slightly higher postoperative perforation rate, likely due to pores within the AlloDerm itself. The closure rate in the Alloderm group was still high at 93%. Audiologic data is analyzed. Conclusions: Temporalis fascia and AlloDerm are both safe and highly effective grafting materials in the reconstruction of the total tympanic membrane perforation if used with the described technique.