Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
Laryngoscope. 2021 Feb;131(2):392-400. doi: 10.1002/lary.28914. Epub 2020 Jul 27.
Nonautologous graft materials may solve several dilemmas in tympanoplasty by obviating the need for graft harvest, facilitating consistent wound healing, and permitting graft placement in the clinical setting. Prior studies of nonautologous grafts in humans have shown variable outcomes. In this systematic review, we aim to 1) summarize clinical outcomes and 2) discuss limitations in the literature regarding nonautologous grafts for tympanoplasty in humans.
A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The study size, etiology and duration of perforation, type of nonautologous graft, and postoperative closure rate were assessed.
The PRISMA approach yielded 61 articles, including 3,247 ears that met inclusion criteria. Studies evaluated nonautologous grafts including paper patch, gelatin sponge, growth factors, porcine small-intestinal submucosa, among others. Traumatic perforations (62.3%) were most commonly studied, whereas postinfectious perforations (31.9%) and other etiologies (5.8%) comprised a minority of cases. Acute perforations of <8 weeks duration constituted just over half of all treated ears. Overall closure rate was 82.1%, with significantly higher closure rates in acute (89.9%) versus chronic perforations (64.9%, P < .01), regardless of material. A median postoperative air-bone gap of 5.6 dB was found in the 23% of studies reporting this metric.
The majority of publications reviewing nonautologous materials in tympanoplasty evaluate acute or traumatic perforations, and few rigorously report hearing outcomes. Given available data, porcine submucosa and basic fibroblast growth factor may hold promise for chronic perforation closure. Future studies should report closure rates and hearing outcomes in perforations >8 weeks duration. Laryngoscope, 131:392-400, 2021.
非自体移植物材料可通过避免移植物采集、促进一致的伤口愈合以及允许在临床环境中放置移植物来解决鼓室成形术中的几个难题。先前在人类中进行的非自体移植物研究显示出不同的结果。在本系统评价中，我们旨在 1）总结临床结果，2）讨论关于人类鼓室成形术中非自体移植物的文献中的局限性。
根据系统评价和荟萃分析的首选报告项目（PRISMA）建议进行文献复习。评估了研究规模、穿孔的病因和持续时间、非自体移植物的类型以及术后闭合率。
采用 PRISMA 方法得到了 61 篇文章，其中包括符合纳入标准的 3247 只耳朵。研究评估了纸片状、明胶海绵、生长因子、猪小肠黏膜下层等非自体移植物。研究最多的是外伤性穿孔（62.3%），而感染后穿孔（31.9%）和其他病因（5.8%）构成了少数病例。急性穿孔持续时间<8 周的比例超过所有治疗耳朵的一半。总体闭合率为 82.1%，急性（89.9%）与慢性穿孔（64.9%，P<.01）的闭合率显著更高，无论材料如何。在报告这一指标的 23%的研究中，发现术后气骨导差中位数为 5.6 dB。
大多数评估鼓室成形术中非自体材料的出版物评估急性或外伤性穿孔，并且很少严格报告听力结果。鉴于现有数据，猪黏膜下层和碱性成纤维细胞生长因子可能对慢性穿孔闭合有希望。未来的研究应报告>8 周持续时间的穿孔的闭合率和听力结果。喉镜，131：392-400，2021。
