Factors influencing successful reconstruction of tympanic membrane perforations: a systematic review and meta-analysis

Abstract

Purpose Based on a systematic review and meta-analysis, our study aimed to provide information about the factors that influence the success of tympanic membrane reconstruction. Methods Our systematic search was conducted on November 24, 2021, using the CENTRAL, Embase, and MEDLINE databases. Observational studies with a minimum of 12 months of follow-up on type I tympanoplasty or myringoplasty were included, while non-English articles, patients with cholesteatoma or specific inflammatory diseases, and ossiculoplasty cases were excluded. The protocol was registered on PROSPERO (registration number: CRD42021289240) and PRISMA reporting guideline was used. Risk of bias was evaluated with the QUIPS tool. A random effect model was used in the analyses. Primary outcome was the rate of closed tympanic cavities. Results After duplicate removal, 9454 articles were found, of which 39 cohort studies were included. Results of four analyses showed significant effects: age (OR: 0.62, CI 0.50; 0.78, p value: 0.0002), size of the perforation (OR: 0.52, CI 0.29; 0.94, p value: 0.033), opposite ear condition (OR: 0.32, CI 0.12; 0.85, p value: 0.028), and the surgeon’s experience (OR: 0.42, CI 0.26; 0.67, p value: 0.005), while prior adenoid surgery, smoking, the site of the perforation, and discharge of the ear did not. Four factors: etiology, Eustachian tube function, concomitant allergic rhinitis, and duration of the ear discharge were analyzed qualitatively. Conclusions The age of the patient, the size of the perforation, the opposite ear status, and the surgeon’s experience have a significant effect on the success of tympanic membrane reconstruction. Further comprehensive studies are needed to analyze the interactions between the factors. Level of evidence Not applicable.

A Proof‐of‐Concept Computer Vision Approach for Measurement of Tympanic Membrane Perforations

“…2,3 Perforation size has also been shown to impact tympanoplasty outcomes. [4][5][6] Previous research has demonstrated clinician inaccuracy in estimating TMP size by visual estimation. [7][8][9] Despite this, gross estimation via visual inspection remains the clinical standard for determining perforation size.…”

“…Size is an important TMP metric as it impacts the degree of hearing loss and the likelihood of spontaneous perforation closure 2,3 . Perforation size has also been shown to impact tympanoplasty outcomes 4–6 . Previous research has demonstrated clinician inaccuracy in estimating TMP size by visual estimation 7–9 .…”

Collagen Matrix to Restore the Tympanic Membrane: Developing a Novel Platform to Treat Perforations

“…A multitude of techniques for the closure of TM perforations is described in the literature, with the application of various autografts (fascial flap, perichondrium, fragments of cartilage, multilayered flaps) and other materials [ 5 , 9 , 12 , 13 , 14 , 15 ]. The efficiency of the surgical treatment depends on many factors, including the applied transplant’s thickness, the surgeon’s experience, and the preparation of the defect edges prior to the procedure [ 16 , 17 ]. However, in any case, there is still a risk of graft failure, its incomplete engraftment or rejection in the post-surgical period, i.e., of TM re-perforation.…”