The impact of middle ear packing materials on tympanoplasty outcomes: a systematic review and meta-analysis.

BACKGROUND

Chronic otitis media and tympanic membrane perforations are common indications for tympanoplasty, where the choice of middle ear packing material critically influences graft survival, hearing restoration, and postoperative complications.

OBJECTIVE

To systematically compare the efficacy and safety of different middle ear packing materials-including platelet-rich fibrin (PRF), hyaluronic acid (HA), Gelfoam, fat, and ciprofloxacin-soaked packing-on tympanoplasty outcomes.

METHODS

A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. PubMed, Embase, and Cochrane Library were searched (2019-2025) for RCTs and cohort studies comparing packing materials in tympanoplasty. Data extraction and quality assessment were performed independently by two reviewers using Covidence, applying the Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale. Random-effects meta-analysis was conducted using RevMan 5.4.

RESULTS

Fifteen studies met inclusion criteria. PRF achieved the highest graft success (93.7%), with HA offering superior hearing improvement (mean ABG closure: 15.2 dB). Both PRF and HA were associated with significantly fewer complications compared to Gelfoam or fat. Bacterial cellulose showed promise for small perforations. Substantial heterogeneity was observed in studies using traditional materials.

CONCLUSION

PRF and HA are superior to traditional packing materials in tympanoplasty, optimising graft survival and functional outcomes. Evidence-based selection of biologically active materials is recommended to improve patient care, with further research needed to standardise protocols and confirm long-term benefits.