Tympanic membrane repair with a dermal allograft

Objectives: To assess the use of an acellular dermal allograft in the repair of chronic tympanic membrane perforations. Chronic tympanic membrane perforations are a common problem in otolaryngology, and although surgical tympanoplasty using either temporalis fascia or rice paper has proven to be highly successful, these materials are not without their own limitations. The search has continued for a simpler, yet equally effective, means of repairing persistent tympanic membrane perforations in an office setting. In this study we experimentally evaluated the use of an acellular dermis (AlloDerm, LifeCell Corporation, The Woodlands, TX) as an alternative to traditional tympanoplasty materials. Study Design: Prospective study using 28 adult chinchillas. Methods: Subtotal tympanic membrane perforations were created bilaterally in 28 adult chinchillas, Animals with noninfected, stable perforations that showed no signs of epithelial regeneration after 5 to 8 weeks were used to compare the use of rice paper patch with AlloDerm in patch tympanoplasties. Results: Eighteen of 23 tympanoplasties (78%) that were performed using AlloDerm showed no signs of perforation after 5 to 6 weeks, In those performed using rice paper control 14 of 21 (66%) showed no signs of perforation after 5 to 6 weeks. In addition, histological evaluation of the heated tympanic membranes demonstrated that the acellular dermis had been incorporated within the middle fibrous layer of the tympanic membrane. Conclusions: The results and histological studies suggest that acellular dermis may be a suitable alternative to traditional materials currently used for patch tympanoplasty. Future studies to evaluate the efficacy of acellular dermis in humans are warranted.