A Novel Decellularized Fibrocartilage Graft Promotes Tympanic Membrane Repair

Tympanoplasty repairs tympanic membrane (TM) perforations using grafts. In pediatric patients, cartilage grafts are preferred over fascia due to superior mechanical properties that prevent complications from negative middle ear pressure, including graft failure, retraction, and cholesteatoma formation. However, autologous grafts cause donor-site morbidity and increased surgical time. To overcome these limitations, we engineered an allogeneic porcine meniscus decellularized (MEND) fibrocartilage graft with a unique microchannel structure created by selective elastin and vascular digestion to promote host cell invasion and integration. We evaluated MEND in a rat TM acute perforation model, comparing outcomes to autologous cartilage and fascia grafts, the current clinical standards of care. TMs were monitored via otoendoscopy through 4 weeks, then analyzed by histology and immunohistochemistry. MEND and auricular cartilage grafts successfully closed perforations by day 3, outperforming fascia grafts which frequently dislodged due to poor mechanical integrity. However, unlike cartilage grafts, MEND fully remodeled by day 28, providing superior graft closure and tissue integration compared to both traditional materials. These findings demonstrate MEND's potential as an off-the-shelf solution for pediatric tympanoplasty.