Which is the best graft for myringoplasty?
Reviewed by Sangeeta Maini and Bhaskar Ram

This is a systematic review and meta-analysis of retrospective studies for type 1 tympanoplasty (myringoplasty) surgery comparing temporalis fascia and cartilage autograft materials for reconstruction. Inclusion criteria was patients with more than 50% perforated tympanic membrane with intact ossicular chain. Patients with atelectasis, cholesteatoma and mastoid surgery were excluded. The main outcomes were graft take rate and air bone gap with a one-year mean follow-up time. Eight studies with 915 patients were analysed. The results showed the graft take was better with full thickness cartilage graft as compared to temporalis fascia grafts. However, as far as the hearing was concerned there was statistically significant difference on subgroup analyses (subgrouping the full thickness and the sliced thickness groups). So, the full thickness cartilage graft showed better hearing outcomes as compared to the sliced cartilage subgroup and temporalis fascia group of patients. This is a meta-analysis study. However, it has the drawback of including only retrospective studies, with obvious disadvantages. Also, historically temporalis fascia continues to be excellent graft material for tympanic reconstruction with great results. To abandon or replace this with full thickness cartilage graft certainly would need more robust evidence!

Comparison of cartilage graft and fascia in type 1 tympanoplasty: systematic review and meta-analysis.
Yang T, Wu X, Peng X, et al.
ACTA OTOLARYNGOLOGICA
2016;136(11):1085-90.