Type I Tympanoplasty Meta-Analysis: Cartilage vs the rest – which graft wins?

Type I Tympanoplasty Meta-Analysis: Cartilage vs the rest – which graft
wins?
Hsern Ern Tan

Objective: To determine which independent variables influencing the efficacy of type I tympanoplasty in adult and pediatric populations.

Data Sources: A search of the PubMed database and Cochrane Database of Systematic Reviews using the key words “tympanoplasty OR myringoplasty” from January 1966 to July 2014 was performed.

Study Selection: Studies reporting outcomes of myringoplasty or Type I tympanoplasty in primary non-cholesteatomatous chronic tympanic membrane perforation were included.

Data Extraction: Of 4,698 abstracts reviewed, 214 studies involving 26,097 cases met our inclusion criteria and contributed to meta-analysis.

Data Synthesis: The primary outcome of success was defined as closure rate at 12 months. The independent variables analyzed were age, follow-up period, approach,
graft material, perforation cause, size, location, ear dryness, and surgical technique. Only those studies providing data on a given parameter of interest could be included
when comparing each variable.

Conclusion: The weighted average success rate of tympanic closure was 86.6%. Based on this meta-analysis, there is a failure rate of tympanoplasty observed over
time (worsened by 4.4% in follow-up periods >12 months). Pediatric surgery has a 5.8% higher failure rate than adults. Other variables associated with improved
closure rates include perforation with a size less than 50% of total area (improved by 6.1%) and the use of cartilage as a graft (improved by 2.8% compared to fascia),
while ears that were operated on while still discharging, those in different locations
of the pars tensa, or using different surgical approaches or techniques did not have
significantly different outcomes.