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Updated: Jun 24, 2026
Techniques of Endoscopic Ossiculoplasty
Published on: January 26, 2024
Endoscopic Type I Tympanoplasty: Comparative Outcomes of Autograft, Allograft, and Xenograft
Yi-Chen Tsai1,2, Chih-Yu Hu2,3,4, Bang-Yan Zhang5,6
1Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan.
Abstract:
ImportanceTo our knowledge, this represents the first adult-only, fully endoscopic, three-arm comparative cohort of autograft, allograft, and xenograft materials in type I tympanoplasty.ObjectiveTo compare graft-take, audiometric outcomes, operative time, and complications among perichondrium, MegaDerm, and Biodesign in adult endoscopic type I tympanoplasty.
Design:
Retrospective comparative cohort study.
Setting:
Tertiary referral center.
Participants:
Adults who underwent endoscopic type I tympanoplasty with perichondrium, MegaDerm or Biodesign between October 2021 and March 2025. Patients with revision surgery, concomitant otologic procedures, active middle-ear disease, profound sensorineural hearing loss, preoperative air-bone gap (ABG) ≥50 dB, or follow-up <3 months were excluded.Intervention or ExposuresEndoscopic type I tympanoplasty using perichondrium (autograft), MegaDerm (allograft), or Biodesign (xenograft).
Main Outcome Measures:
Graft-take rate, hearing gain (air-conduction and ABG), operative time, and complications.ResultsNinety-three ears were analyzed (perichondrium n = 33; MegaDerm n = 21; Biodesign n = 39). Three-month graft-take rates were similar, and final graft-take rates remained comparable across groups (3 months: 90.9%, 90.5%, 94.9%; P = .6862; final: 84.8%, 85.7%, 84.6%; P > .999). Air-conduction (AC) and ABG improved significantly within all groups. Between-group differences were not significant for AC gain (13.79 ± 9.84 vs 7.24 ± 12.46 vs 9.14 ± 10.01 dB; P = .0804) or ABG gain (9.58 ± 10.46 vs 8.82 ± 10.37 vs 7.58 ± 8.46 dB; P = .7757); the proportion achieving postoperative ABG ≤20 dB was similar (P = .475). Operative time was significantly longer for perichondrium (98.23 ± 32.35, 68.52 ± 20.84, and 74.88 ± 17.27; P < .0001). Complications were infrequent (otomycosis, n = 3; myringitis, n = 1), and no facial palsy, intractable vertigo, profound sensorineural hearing loss(SNHL), or dysgeusia occurred.
Conclusion:
In adult endoscopic type I tympanoplasty, perichondrium, MegaDerm, and Biodesign demonstrated comparable short-term graft-take and audiometric outcomes, while commercially available grafts were associated with shorter operative time.
Relevance:
These findings support patient-centered graft selection balancing donor-site considerations, operative efficiency, and cost; prospective studies with standardized follow-up and patient-reported outcomes are warranted.
