Is cartilage tympanoplasty more effective than fascia tympanoplasty? A systematic review

Objective: A systematic review to compare the effectiveness of the use of cartilage (with or without perichondrium) with temporalis fascia used in tympanoplasty.

Data Source: The following databases were searched for relevant studies: MEDLINE, Embase, CINAHL, the Cochrane Library including the Cochrane Central Register of Controlled Trials, Google scholar, and the PubMed. There was no restriction as to the design or date of publication.

Study Selections: We selected randomized controlled trials (RCTs) and retrospective studies comparing cartilage and temporalis fascia tympanoplasty in relation to 2 outcomes: morphological and functional success. Initial search identified 2,091 publications. All titles and abstracts were reviewed by 2 of the authors, and 103 relevant articles were studied. However, only 14 studies met the inclusion criteria for this review. These included 3 RCTs, 10 retrospective studies, and 1 literature review.

Results: Three level 1 (RCTs) and 11 level 3 and 4 evidence-based studies were included (n = 1,475 patients). One RCT and 3 retrospective studies showed a statistically significant better morphological success, that is, intact ear drum with cartilage graft with or without perichondrium. There was, however, no statistically significant difference between cartilage and temporalis fascia tympanoplasty regarding function, namely, hearing outcome. The need for revision rates was approximately 10% with cartilage and 19% with fascia tympanoplasty.

Conclusion: Tympanoplasty using cartilage with or without perichondrium has better morphological outcome than tympanoplasty using temporalis fascia. However, there was no statistically significant difference in hearing outcomes between the 2 grafts.