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Comparison of temporalis muscle fascia and cartilage grafts for primary type 1 tympanoplasty: a meta-analysis of randomized controlled trials

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Abstract

Purpose

To compare the efficacy and safety of temporalis fascia (TF) with cartilage grafts for primary type 1 tympanoplasty in chronic otitis media (COM) patients.

Methods

Computerized search was performed in MEDLINE, Embase, and CENTRAL. Eligible for inclusion were randomized controlled trials (RCTs) comparing TF and cartilage grafts in individuals with non-cholesteatoma COM and intact ossicles requiring type 1 tympanoplasty. Primary outcomes were graft success and hearing improvement, measured by the air–bone gap (ABG) closure. The secondary outcome was the occurrence of complications. Standardized mean differences (SMD) and odds ratios (OR) with 95% confidence intervals were calculated.

Results

Eighteen RCTs that enrolled 1273 participants were found eligible. Data were reported at follow-up periods ranging from 6 weeks to 24 months. The pooled effect estimate revealed a higher and statistically significant graft success favoring cartilage grafts at 12 months (OR = 2.24, 95% CI 1.33–3.78) and 24 months (OR = 2.96, 95% CI 1.18–7.43). There was no significant difference between both grafts in post-operative ABG closure across all follow-up periods (6 weeks to 12 months).

Conclusions

Compared to TF, primary type 1 cartilage tympanoplasty offers better graft uptake rates and comparable postoperative hearing outcomes for COM patients.

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References

  1. Schilder AG, Chonmaitree T, Cripps AW et al (2016) Otitis media. Nat Rev Dis Prim 2(1):16063. https://doi.org/10.1038/nrdp.2016.63

    Article  PubMed  Google Scholar 

  2. Zöllner F (1955) The principles of plastic surgery of the sound-conducting apparatus. J Laryngol Otol 69(10):637–652. https://doi.org/10.1017/S0022215100051240

    Article  PubMed  Google Scholar 

  3. Wullstein H (1952) Funktionelle Operationen im mittelohr mit hilfe des freien spaltlappen-transplantates. Archiv f Ohren-, Nasen- u Kehlkopfheilkd 161:422–435. https://doi.org/10.1007/BF02129204

    Article  Google Scholar 

  4. Phillips JS, Yung MW, Nunney I (2015) Myringoplasty outcomes in the UK. J Laryngol Otol 129(9):860–864. https://doi.org/10.1017/s002221511500198x

    Article  CAS  PubMed  Google Scholar 

  5. Dornhoffer J (2003) Cartilage tympanoplasty: indications, techniques, and outcomes in a 1000-patient series. Laryngoscope 113(11):1844–1856. https://doi.org/10.1097/00005537-200311000-00002

    Article  PubMed  Google Scholar 

  6. Lyons SA, Su T, Vissers LE, Peters JP, Smit AL, Grolman W (2016) Fascia compared to one-piece composite cartilage-perichondrium grafting for tympanoplasty. Laryngoscope 126(7):1662–1670. https://doi.org/10.1002/lary.25772

    Article  PubMed  Google Scholar 

  7. Iacovou E, Vlastarakos PV, Papacharalampous G, Kyrodimos E, Nikolopoulos TP (2013) Is cartilage better than temporalis muscle fascia in type I tympanoplasty? Implications for current surgical practice. Eur Arch Otorhinolaryngol 270(11):2803–2813. https://doi.org/10.1007/s00405-012-2329-4

    Article  PubMed  Google Scholar 

  8. Tan HE, Santa Maria PL, Eikelboom RH, Anandacoomaraswamy KS, Atlas MD (2016) Type I tympanoplasty meta-analysis: a single variable analysis. Otol Neurotol 37(7):838–846. https://doi.org/10.1097/MAO.0000000000001099

    Article  PubMed  Google Scholar 

  9. Jalali MM, Motasaddi M, Kouhi A, Dabiri S, Soleimani R (2017) Comparison of cartilage with temporalis fascia tympanoplasty: a meta-analysis of comparative studies. Laryngoscope 127(9):2139–2148. https://doi.org/10.1002/lary.26451

    Article  PubMed  Google Scholar 

  10. Yang T, Wu X, Peng X, Zhang Y, Xie S, Sun H (2016) Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis. Acta Otolaryngol 136(11):1085–1090. https://doi.org/10.1080/00016489.2016.1195013

    Article  CAS  PubMed  Google Scholar 

  11. Bhattacharya SN, Pal S, Saha S, Gure PK, Roy A (2016) Comparison of a microsliced modified chondroperichondrium shield graft and a temporalis fascia graft in primary type I tympanoplasty: a prospective randomized controlled trial. Ear Nose Throat J 95(7):274–283

    PubMed  Google Scholar 

  12. Arora N, Passey JC, Agarwal AK, Bansal R (2017) Type 1 tympanoplasty by cartilage palisade and temporalis fascia technique: a comparison. Indian J Otolaryngol Head Neck Surg 69(3):380–384. https://doi.org/10.1007/s12070-017-1137-y

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bhardwaj B, Singh J (2019) Comparative study of hearing improvement of type 1 tympanoplasty using temporalis fascia and conchal cartilage as graft material. Indian J Otolaryngol Head Neck Surg 71(Suppl 2):1174–1178. https://doi.org/10.1007/s12070-018-1248-0

    Article  PubMed  Google Scholar 

  14. Asghari A, Mohseni M, Daneshi A, Nasoori Y, Rostami S, Balali M (2018) Randomized clinical trial comparing bucket handle and cartilage tympanoplasty techniques for the reconstruction of subtotal or anterior tympanic membrane perforation. Int J Otolaryngol 2018:2431023. https://doi.org/10.1155/2018/2431023

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ciğer E, Balcı MK, İşlek A, Önal K (2018) The wheel-shaped composite cartilage graft (WsCCG) and temporalis fascia for type 1 tympanoplasty: a prospective, randomized study. Eur Arch Otorhinolaryngol 275(12):2975–2981. https://doi.org/10.1007/s00405-018-5171-5

    Article  PubMed  Google Scholar 

  16. Jain A, Samdani S, Sharma MP, Meena V (2018) Island cartilage vs temporalis fascia in type 1 tympanoplasty: a prospective study. Acta Otorrinolaringol Esp (Engl Ed) 69(6):311–317. https://doi.org/10.1016/j.otorri.2017.10.004

    Article  PubMed  Google Scholar 

  17. Wahid F-I, Nagra SR (2020) Comparison of half-thickness tragal cartilage graft to temporalis fascia graft tympanoplasty type I: a randomized control trial. J Pak Med Assoc 70(4):602–606. https://doi.org/10.5455/JPMA.16032

    Article  Google Scholar 

  18. Nithya R, Gangani HM, Aiyer RG, Gupta RR (2022) Is cartilage a better option than temporalis fascia for grafting in type 1 tympanoplasty? An institutional study. Indian J Otolaryngol Head Neck Surg 74(Suppl 1):246–251. https://doi.org/10.1007/s12070-020-02037-y

    Article  CAS  PubMed  Google Scholar 

  19. Lou Z (2020) Endoscopic myringoplasty in pediatric patients: a comparison of cartilage graft push-through and underlay fascia graft techniques. Acta Otolaryngol 140(11):893–898. https://doi.org/10.1080/00016489.2020.1787510

    Article  PubMed  Google Scholar 

  20. Lou ZC (2020) Endoscopic myringoplasty: comparison of double layer cartilage-perichondrium graft and single fascia grafting. J Otolaryngol Head Neck Surg 49(1):40. https://doi.org/10.1186/s40463-020-00440-7

    Article  PubMed  PubMed Central  Google Scholar 

  21. Khafagy AG, Sobhy TS, Afifi PO (2020) Do mastoidectomy and type of graft affect tympanoplasty outcome in Egyptian children? A prospective randomized study. Egypt J Otolaryngol 36:1–6. https://doi.org/10.1186/s43163-020-00009-1

    Article  Google Scholar 

  22. Venkatesan D, Umamaheswaran P, Vellikkannu R, Kannan S, Sivaraman A, Ramamurthy S (2022) A comparative study of temporalis fascia graft and full thickness Tragal island cartilage graft in type 1 tympanoplasty. Indian J Otolaryngol Head Neck Surg 74(Suppl 1):619–623. https://doi.org/10.1007/s12070-021-02459-2

    Article  PubMed  Google Scholar 

  23. Reddy CRVB, Thejas SR (2022) Comparison between tragal cartilage and temporalis fascia in type 1 tympanoplasty: a prospective comparative study. Eur J Mol Clin Med 9(4):645–656

    Google Scholar 

  24. Shrestha BL, Shakya S, Pradhan A, Dhakal A, KC AK, S. K. (2022) Comparison of hearing result and graft uptake rate between temporalis fascia and tragal cartilage in endoscopic myringoplasty. Kathmandu Univ Med J 79(3):359–365

    Article  Google Scholar 

  25. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https://doi.org/10.1371/journal.pmed.1000100

    Article  PubMed  PubMed Central  Google Scholar 

  26. Katz J (2014) Handbook of clinical audiology, 7th edn. Lippincott Williams and Wilkins

    Google Scholar 

  27. Sterne JAC, Savović J, Page MJ et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898. https://doi.org/10.1136/bmj.l4898

    Article  PubMed  Google Scholar 

  28. Guyatt G, Oxman AD, Akl EA et al (2011) GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 64(4):383–394. https://doi.org/10.1016/j.jclinepi.2010.04.026

    Article  PubMed  Google Scholar 

  29. Wafaie M, Elsherif AM, Bakr MS (2010) Comparative study of the clinical and audiological outcome of myringoplasty using temporalis fascia graft versus tragal cartilage graft. Al-Azhar Assiut Med J 8(2):190–201

    Google Scholar 

  30. Arun KC, Shakya D (2014) Comparison of outcomes of myringoplasty with cartilage palisades and temporalis fascia in large perforations. Otolaryngol Head Neck Surg 151(1 suppl):199. https://doi.org/10.1177/0194599814541629a194

    Article  Google Scholar 

  31. Maheshwari A, Panigrahi R, Mahajan S (2015) Comparison of temporalis fascia with tragal cartilage-perichondrium (composite graft) as a grafting material in type I tympanoplasty: a prospective randomized study. Int J Sci Study 3(1):29–34. https://doi.org/10.17354/ijss/2015/150

    Article  Google Scholar 

  32. Tripathi P, Guragain RP, Bhusal CL, Karna SL, Borgstein J (2015) A comparison of two myringoplasty techniques in Nepalese children: a prospective randomized trial. Int J Pediatr Otorhinolaryngol 79(9):1556–1560. https://doi.org/10.1016/j.ijporl.2015.07.014

    Article  PubMed  Google Scholar 

  33. Vartiainen E (1993) Findings in revision myringoplasty. Ear Nose Throat J 72(3):201–204

    Article  CAS  PubMed  Google Scholar 

  34. Berger G, Ophir D, Berco E, Sadé J (1997) Revision myringoplasty. J Laryngol Otol 111(6):517–520

    Article  CAS  PubMed  Google Scholar 

  35. Indorewala S, Pagare R, Aboojiwala S, Barpande S (2004) Dimensional stability of the free fascia grafts: a human study. Laryngoscope 114(3):543–547. https://doi.org/10.1097/00005537-200403000-00029

    Article  PubMed  Google Scholar 

  36. Yamamoto E, Iwanaga M, Fukumoto M (1988) Histologic study of homograft cartilages implanted in the middle ear. Otolaryngol-Head Neck Surg 98(6):546–551. https://doi.org/10.1177/019459988809800602

    Article  CAS  PubMed  Google Scholar 

  37. Hamed M, Samir M, El Bigermy M (1999) Fate of cartilage material used in middle ear surgery light and electron microscopy study. Auris Nasus Larynx 26(3):257–262. https://doi.org/10.1016/s0385-8146(99)00012-7

    Article  CAS  PubMed  Google Scholar 

  38. Maroudas A (1975) Biophysical chemistry of cartilaginous tissues with special reference to solute and fluid transport. Biorheology 12(3–4):233–248. https://doi.org/10.3233/bir-1975-123-416

    Article  CAS  PubMed  Google Scholar 

  39. Gerber MJ, Mason JC, Lambert PR (2000) Hearing results after primary cartilage tympanoplasty. Laryngoscope 110:1994–1999. https://doi.org/10.1097/00005537-200012000-00002

    Article  CAS  PubMed  Google Scholar 

  40. Malhotra T, Jha S, Kamal D, Thakur V (2022) Tympanoplasty in high-risk perforation and atelectatic ear using perichondrium-cartilage island graft and temporalis fascia a comparative analysis. J Mar Med Soc 24(1):24–29. https://doi.org/10.4103/jmms.jmms_41_21

    Article  Google Scholar 

  41. Cavaliere M, Mottola G, Rondinelli M, Iemma M (2009) Tragal cartilage in tympanoplasty: anatomic and functional results in 306 cases. Acta Otorhinolaryngol Ital: Organo Uff Della Soc Ital Otorinolaringol Chir Cervico-facciale 29(1):27–32

    CAS  Google Scholar 

  42. Neumann A, Kevenhoerster K, Gostian AO (2010) Long-term results of palisade cartilage tympanoplasty. Otol Neurotol 31(6):936–939. https://doi.org/10.1097/mao.0b013e3181e71479

    Article  PubMed  Google Scholar 

  43. Guler I, Baklaci D, Kuzucu I, Kum RO, Ozcan M (2018) Comparison of temporalis fascia and tragal cartilage grafts in type 1 tympanoplasty in elderly patients. Auris Nasus Larynx. https://doi.org/10.1016/j.anl.2018.09.003

    Article  PubMed  Google Scholar 

  44. Onal K, Arslanoglu S, Songu M, Demiray U, Demirpehlivan IA (2012) Functional results of temporalis fascia versus cartilage tympanoplasty in patients with bilateral chronic otitis media. J Laryngol Otol 126(1):22–25. https://doi.org/10.1017/s0022215111002817

    Article  CAS  PubMed  Google Scholar 

  45. Mohanty S, Manimaran V, Umamaheswaran P, Jeyabalakrishnan S, Chelladurai S (2018) Endoscopic cartilage versus temporalis fascia grafting for anterior quadrant tympanic perforations - a prospective study in a tertiary care hospital. Auris Nasus Larynx 45(5):936–942. https://doi.org/10.1016/j.anl.2018.01.002

    Article  PubMed  Google Scholar 

  46. Ferlito S, Fadda G, Lechien JR, Cammaroto G, Bartel R, Borello A, Cavallo G, Piccinini F, La Mantia I, Cocuzza S, Merlino F, Achena A, Brucale C, Mat Q, Gargula S, Fakhry N, Maniaci A (2022) Type 1 tympanoplasty outcomes between cartilage and temporal fascia grafts: a long-term retrospective study. J Clin Med 11(23):7000. https://doi.org/10.3390/jcm11237000

    Article  PubMed  PubMed Central  Google Scholar 

  47. Çayir S, Kayabaşi S (2019) Type 1 tympanoplasty in pediatric patients: comparison of fascia and perichondrium grafts. Int J Pediatr Otorhinolaryngol 121:95–98. https://doi.org/10.1016/j.ijporl.2019.03.007

    Article  PubMed  Google Scholar 

  48. Hu YQ, Zou MZ, Sun H et al (2022) Tragus perichondrium-cartilage island and temporalis muscle fascia for repairing tympanic membrane perforation under the otoendoscope: a randomized controlled trial. Ear Nose Throat J. https://doi.org/10.1177/01455613221130884

    Article  PubMed  Google Scholar 

  49. Bozdemir K, Kutluhan A, Yalçıner G, Tarlak B, Bilgen AS (2012) Tympanoplasty with island cartilage or temporalis fascia: a comparative study. ORL J Otorhinolaryngol Relat Spec 74(1):28–32. https://doi.org/10.1159/000335056

    Article  PubMed  Google Scholar 

  50. Atef A, Talaat N, Fathi A, Mosleh M, Safwat S (2007) Effect of the thickness of the cartilage disk on the hearing results after perichondrium/cartilage island flap tympanoplasty. ORL J Otorhinolaryngol Relat Spec 69(4):207–211. https://doi.org/10.1159/000101540

    Article  PubMed  Google Scholar 

  51. Parelkar K, Thorawade V, Marfatia H, Shere D (2020) Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft. Braz J Otorhinolaryngol 86(3):308–314. https://doi.org/10.1016/j.bjorl.2018.12.006

    Article  PubMed  Google Scholar 

  52. Emami H, Erfanian R, Berijani S, Alizadeh P, Amirzargar B (2022) Is cartilage thickness important in cartilage tympanoplasty? A systematic review and meta-analysis. Indian J Otolaryngol Head Neck Surg 74(4):456–462. https://doi.org/10.1007/s12070-021-02781-9

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

    Ghassan Bin Lajdam, Rana A. Alahmadi, Mohammed Alhakami, Abdullah A. Ghaddaf & Ahmed S. Abdulhamid

  2. King Abdullah International Medical Research Center, Jeddah, Saudi Arabia

    Ghassan Bin Lajdam, Rana A. Alahmadi, Mohammed Alhakami, Abdullah A. Ghaddaf & Ahmed S. Abdulhamid

  3. King Abdullah Ear Specialist Center (KAESC), College of Medicine, King Saud University Medical City (KSUMC), King Saud University, Riyadh, Saudi Arabia

    Asma Alahmadi & Abdulrahman Hagr

  4. Research Department, MED-EL GmbH, Riyadh, Saudi Arabia

    Yassin Abdelsamad

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  1. Ghassan Bin Lajdam
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Contributions

GBL: research idea, data extraction, risk of bias assessment, statistical analysis/interpretation, creating the tables, and writing the manuscript. RAA: protocol revision, screening, data extraction, risk of bias assessment, and critical revision of the manuscript with additions and corrections. MA: screening, data extraction, and risk of bias assessment. AAG: design/protocol of the study, creating the data extraction model, statistical analysis/interpretation, and certainty of evidence assessment. ASA: screening, data extraction, and risk of bias assessment. AA: idea discussion and critical revision with additions and corrections of the manuscript. YA: critical revision with additions and corrections of the manuscript. AH: critical revision with additions and corrections of the manuscript.

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Correspondence to Ghassan Bin Lajdam.

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Lajdam, G.B., Alahmadi, R.A., Alhakami, M. et al. Comparison of temporalis muscle fascia and cartilage grafts for primary type 1 tympanoplasty: a meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol 280, 5153–5165 (2023). https://doi.org/10.1007/s00405-023-08170-y

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