Complications of homograft tympanoplasty.

The use of a homograft tympanic membrane with an attached malleus has provided an excellent alternative for reconstructing the severely damaged middle ear. I have limited homograft tympanoplasty to four specific indications: previous failure of standard tympanoplasty techniques, high risk of failure (total perforation, absent malleus, slag burns), reconstruction of radical mastoidectomy, and congenital aural atresia. Homograft tympanoplasty has provided a 94 per cent incidence of anatomic success in these severely damaged middle ears. Closure of the air-bone gap to within 25 dB. was accomplished in 85 per cent of these patients. Complications must be viewed in the perspective of the extensive disease in the middle ear that was being reconstructed. Only meticulous attention to surgical technique and postoperative care will provide the successes described by Wehrs, Marquet, Perkins, and others. The otologic surgeon is urged to observe the surgical techniques of homograft tympanoplasty rather than merely read about it. I believe that the transplant tympanic membrane should be used only when it provides an advantage over standard grafting techniques. Underlay fascia tympanoplasty yields excellent results in the majority of eardrum reconstructions. A final word about homograft tympanic membrane and ossicles. Although several "banks" for ear tissue are available in the United States, there are few established guidelines that these banks are required to follow. The otologic surgeon who uses homograft tissue must be guaranteed that the biologic product he is implanting in his patient is sterile, is anatomically perfect, has been stored in a chemically stable preservative, and has proven biologic effectiveness. Ear banks should be managed by surgeons who are using that tissue in their own patients, thus monitoring the tissue's quality. Each bank has a responsibility to donors, recipients, and surgeons to maintain the highest laboratory standards that will guarantee the quality of its product. Since there is no regulating agency, the practicing physician should insist that these standards for processed homograft ear tissue be maintained.