Chronic tympanic membrane perforation closure: from historical aspects to modern methods

Abstract

The article presents the different grafts for chronic tympanic membrane perforation closure. The types of surgical treatment of chronic otitis media are described in a historical aspect. The initially proposed vascularized skin grafts were quickly replaced by a range of connective tissue autografts. Authors indicated a few studies in which fascia lata, venous wall, periosteum were used for myringoplasty. However, these tissues are not widely used in otosurgery. The special attention is given to the comparative studies on the outcomes of closure with fascial and cartilage grafts. The last ones are currently most commonly used for myringoplasty. Nonetheless, the use of each of these grafts is associated with indicated in the literature advantages and disadvantages. The cartilaginous grafts allow to close rather big perforations, but with lack of flexibility and pliability. On the other hand, flexible perichondrium and fascia improve the mechanical properties of neotympanic membrane yet increasing the risk of retraction and reperforation. Therefore, the search of alternative treatment for chronic tympanic membrane perforation is lasting at present. There are many studies on regenerative medicine in foreign literature. The tissue engineering approach allows to repair the damaged tissue due to proliferation of pluripotent cells and activation of their migration. The tympanic membrane regenerative potential eliminates the need for external stem cells and allows to use less complicated “in situ” tissue engineering technique. The key of this technique is the combination of the regeneration regulating factors with temporary supporting scaffolds. The authors also describe the advantages of the modern tissue engineering approach and prospects for its further application to clinical practice.