Abstract
Allograft tympano-ossicular systems (ATOS) have proven their use over many decades in tympanoplasty and reconstruction after resection of cholesteatoma. The transcranial bone plug technique has been used in the past 50 years to procure en bloc ATOS (tympanic membrane with malleus, incus and stapes attached). Recently, our group reported the feasibility of the endoscopic procurement technique. The aim of this study was to assess whether clinical outcome is equivalent in ATOS acquired by using the endoscopic procurement technique compared to ATOS acquired by using the transcranial technique. A double-blind randomized controlled audit was performed in a tertiary referral center in patients that underwent allograft tympanoplasty because of chronic otitis media with and without cholesteatoma. Allograft epithelialisation was evaluated at the short-term postoperative visit by microscopic examination. Failures were reported if reperforation was observed. Fifty patients underwent allograft tympanoplasty: 34 received endoscopically procured ATOS and 16 received transcranially procured ATOS. One failed case was observed, in the endoscopic procurement group. We did not observe a statistically significant difference between the two groups in failure rate. This study demonstrates equivalence of the clinical outcome of allograft tympanoplasty using either endoscopic or transcranial procured ATOS and therefore indicates that the endoscopic technique can be considered the new standard procurement technique. Especially because the endoscopic procurement technique has several advantages compared to the former transcranial procurement technique: it avoids risk of prion transmission and it is faster while lacking any noticeable incision.
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Andersen SA, Aabenhus K, Glad H, Sørensen MS (2014) Graft take-rates after tympanoplasty: results from a prospective ear surgery database. Otol Neurotol 35:e292–e297
Caremans J, Hamans E, Muylle L, Van de Heyning P, Van Rompaey V (2015) Endoscopic procurement of allograft tympano-ossicular systems: valuable to replace the Schuknecht bone plug technique? Cell Tissue Bank 16:91–96
Chalat N (1964) Tympanic membrane transplant. Harper Hosp Bull 22:27–34
Marquet J (1966) Reconstructive micro-surgery of the eardrum by means of a tympanic membrane homograft. Preliminary report. Acta Otolaryngol 62:459–464
Marquet J (1971) Human middle ear transplants. J Laryngol Otol 85:523–539
Marquet J (1977) Historical notes on homografts. Otolaryngol Clin N Am 10:479–485
Merchant S, Nadol J (2010) Schuknecht’s pathology of the ear. McGraw-Hill, Ontario
Meylan P, Duscher A, Mudry A, Monnier P (1996) Risk of transmission of human immunodeficiency virus infection during tympano-ossicular homograft: an experimental study. Laryngoscope 106:334–337
Somers T, Van Rompaey V, Claes G, Salembier L, van Dinther J, Zarowski A, Offeciers E (2012) Ossicular reconstruction: hydroxyapatite bone cement versus incus remodelling: how to manage incudostapedial discontinuity. Eur Arch Otorhinolaryngol 269:1095–1101
Van Rompaey V, Yung M, Claes J, Hausler R, Martin C, Somers T, Offeciers E, Pytel L, Skladzien J, Van de Heyning P (2009) Prospective effectiveness of stapes surgery for otosclerosis in a multicenter audit setting: feasibility of the Common Otology Database as a benchmark database. Otol Neurotol 30:1101–1110
Van Rompaey V, Yung M, Van de Heyning P (2010) Auditing in middle ear surgery, feasibility of the common otology database. B-ENT 6:189–194
Van Rompaey V, van Dinther J, Somers T, Vanhoof L, Maes M, Schatteman I, Offeciers E (2012a) Transmeatal procurement of allograft tympano-ossicular systems: preliminary report (Alternative to the intracranial bone plug technique by Schuknecht). Int Adv Otol 8:154–157
Van Rompaey V, Vandamme W, Muylle L, Van de Heyning P (2012b) Temporal bone bank: complying with European Union directives on human tissue and cells. Cell Tissue Bank 13:231–240
Van Rompaey V, Caremans J, Hamans E, Muylle L, Van de Heyning P (2013a) Endoscopic procurement of tympano-ossicular allografts: alternative to the transcranial or retroauricular technique. Cell Tissue Bank 14:511–514
Van Rompaey V, Farr M, Hamans E, Mudry A, Van de Heyning P (2013b) Allograft tympanoplasty: a historical perspective. Otol Neurotol 34:180–188
Acknowledgments
We would like to thank all additional ENT surgeons involved in the reported allograft tympanoplasty cases: Paul Govaerts, Anouk Peeters, Jozef Claes, Carl Van Laer and Erwin Koekelkoren.
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Caremans, J., Hamans, E., Muylle, L. et al. Endoscopic versus transcranial procurement of allograft tympano-ossicular systems: a prospective double-blind randomized controlled audit. Cell Tissue Bank 17, 199–204 (2016). https://doi.org/10.1007/s10561-015-9531-8
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DOI: https://doi.org/10.1007/s10561-015-9531-8