Homograft (allograft) tympanoplasty update

If homograft tympanoplasty is to be of value, specific instances in which homograft tympanic membrane, malleus, and incus (TMMI) provide significant hearing and anatomical advantages over standard techniques should be identified. This author has performed 305 homograft tympanoplasties limited to the reconstruction of the severely damaged middle ear. Indications include: previous failure with standard tympanoplasty techniques; high risk of anatomic or hearing failure with standard techniques (total perforation with absent malleus, slag burns); reconstruction of radical mastoidectomy; congenital aural atresia. The first 125 consecutive homograft tympanoplasties were reported in 1982. One hundred eighty additional homograft tympanoplasties have been performed since then. In the past 3 years the anatomic success rate has risen to 97% (174/180) with refinement of surgical techniques. Eighty-five percent of all patients have maintained an average air-bone gap of 25 dB or better. Formalin preserved homograft tympanic membranes with attached malleus offer significant advantages over standard tympanoplasty techniques in these specific indications.