Learning Objectives:

Introduction: Biodesign is an artificial graft material. This work assesses the feasibility of performing middle ear reconstruction with biodesign and the short and long-term results on closure of perforations and hearing.

Methods: We performed a retrospective study of 18 children who had middle ear reconstruction using biodesign during endoscopic and conventional ear surgery for chronic suppurative otitis media. The surgeries were performed between February 2014 and February 2015 by the senior author.

Results: Nine surgeries were endoscopic tympanoplasty, 3 were endoscope-assisted tympanoplasty, 2 were conventional microscope tympanoplasty, two were endoscopic tympanoplasty for cholesteatoma and remaining two were combined approach tympanoplasty (CAT) for cholesteatoma. At 3 months follow up 17 (94%) of the grafts were intact while one had a pin-hole perforation. Over the period of follow-up of 12 months, one patient with cholesteatoma (endoscopic tympanoplasty) underwent a mastoidectomy for recurrence. One patient who underwent a CAT had a second look procedure while the other presented with recurrent disease. One patient (endosopic myringoplasty) underwent a revision endoscopic myringoplasty. The patient who had a pin hole perforation at 3 month follow up went on to develop a retraction and a tympanoplasty with cartilage grafting is planned. Rest of the patients (72%) have had no further trouble with their ears.

Conclusion: The early results with biodesign in the reconstruction of middle ear are very good (94% intact graft rate). The biodesign graft continues to do well in the group of patients undergoing myringoplasty even after a follow up of 12 months with intact grafts in 11 of 14 patients (78%).

Learning points: Biodesign is a good substitute for temporalis fascia, obviates the need for a separate scar with endoscopic ear surgery and is very useful in repeat mastoid surgeries where temporalis fascia may be scarce.