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This retrospective case review looks at the experience of a single unit using a variety of autologous (temporalis fascia, n=292) and non-autologous graft material, n=241 (alloderm (human dermis), biodesign (porcine submucosa, $170-$255) and tutoplast (human pericardium, $350). The average patient age was nine years, and there was a total of 564 procedures over almost a 20-year period. Myringoplasty procedures involving solely tympanic membrane work, with no tympanomeatal flap, and all revision cases were excluded. Equal numbers of postauricular and transcanal approaches were involved. Success was defined as an intact TM at 12 months or last follow-up if less than that - 35% did not have 12-month follow-up which was cited as a limitation of the study. The overall closure rate in this study was 79%. This compares with meta-analysis rates of 83% for paediatric tympanoplasty in recent literature. None of the non-autologous graft materials showed a statistically-significant difference in the hazard of failure compared with temporalis fascia. In all groups, 70-80% of failures occurred by six months postoperatively. There was a statistical higher hazard of failure for larger perforations (>50% of TM) compared with smaller perforations, in all groups. Age of the patient did not have an effect on the outcome in any group. There was a bias in the temporalis fascia group as it had greater numbers of both larger and more anterior perforations. This study demonstrates the surgical equivalence of non-autologous materials with native fascia and this has implications for paediatric tympanoplasty, particularly in the era of endoscopic ear surgery. The study also looked briefly at cost-analysis, and by estimating that not needing to harvest a graft would save up to 19 minutes, at a cost of $30-$80/minute, they demonstrated cost-effectiveness of these non-autologous products. Although far from a perfect evidence base due to the bias of the retrospective design/patient selection/short follow-up, this is an interesting study demonstrating the role that non-autologous grafts can play in the current surgical management of paediatric perforations.

Pediatric Primary Tympanoplasty Outcomes With Autologous and Non-autologous Grafts.
Cass N, Hebbe A, Meier M, et al.
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Aileen Lambert

Great Ormond Street Hospital, London, UK.

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