Gelatin versus chitosan as packing materials in endoscopic myringoplasty for chronic suppurative otitis media

There is a lack of literature studying the impact of various middle ear packing materials on the outcomes of myringoplasty. Absorbable gelatin sponge is commonly used, though it has been reported to induce middle ear fibrosis or adhesions. Chitosan-based sponge has useful properties including hemostasis, anti-adhesion and antimicrobial activity, potentially making it useful for supporting the graft in myringoplasty. This study compares graft success when chitosan and gelatin are used as packing materials for endoscopic myringoplasty.

An audit was performed of all patients who underwent endoscopic myringoplasty for chronic suppurative otitis media under the Otolaryngology department of Ng Teng Fong General Hospital between June 2021 and March 2024. Patients were followed up at least 3 months after surgery. Graft success was defined as the presence of an intact graft without perforation at the end of 3 months.

91 patients were analyzed. Gelatin and chitosan were used in 40 and 51 patients respectively. The overall graft success rate of the 91 cases was 79.1 %(n = 72). Tragal perichondrium was most commonly used(46.1 %, n = 42/91), with a success rate of 80.9 %(n = 34/42). The differences in graft success rates among the various graft types and across perforation sizes were not statistically significant.(p = 0.129 and p = 0.399 respectively) There was no significant difference in the success rate between the chitosan group(80.4 %, n = 41/51) and the gelatin group(77.5 %, n = 31/40).(p = 0.736).

Chitosan-based packing affords at least equivalent success when compared to gelatin-based packing for endoscopic myringoplasty. It should be considered as a competitive alternative given its other benefits.