Tympanic membrane defect repair remains one of the key challenges in otorhinolaryngology, particularly in cases of large and complex perforations, recurrent cases, and impaired middle ear ventilation. Traditionally, autologous materials—such as temporalis fascia, perichondrium, and cartilage-perichondrial flaps—are used for reconstruction. However, the limited availability of donor material, the need for additional surgical procedures, and the risk of graft rejection have stimulated the search for alternative solutions, including the use of allografts (of human or animal origin) and the application of multilayer techniques, such as two- and three-layer (multi-layer) tympanoplasty. This review examines recent publications on the use of autografts and allografts, including studies on acellular dermal allografts (e.g., AlloDerm) for tympanic membrane reconstruction, the use of fascia lata allografts, as well as descriptions of three-layer techniques (e.g., tri-layer tympanoplasty) for complex defects. In conclusion, the use of multilayer auto- and allografts represents a promising approach in tympanic membrane repair, particularly in “high-risk” cases; however, individualization of the technique, the condition of the middle ear, and material selection should be carefully considered.

Tympanic membrane, perforation, allograft, tri-layer tympanoplasty

Benecke JE Jr, Glasscock ME 3rd, Cacciatore J, et al. Tympanic membrane grafting with AlloDerm. Otolaryngol Head Neck Surg. 2001;125(1):85–9.

Downey TJ, Jackson CG, Tami TA, et al. AlloDerm tympanoplasty of tympanic membrane perforations. Laryngoscope. 2003;113(10):1836–40.

Haynes DS, Brackmann DE, Eavey RD. Acellular allograft dermal matrix for tympanoplasty. Otol Neurotol. 2005;26(4):609–13.

Lee JM, Kim MJ, Kim HJ, et al. Surgical outcomes of tympanoplasty using a sterile acellular dermal allograft: a prospective randomized controlled study. Clin Exp Otorhinolaryngol. 2018;11(2):123–9.

Xu S, Tjosvold L, Li Y, et al. Human-derived acellular dermal matrix may be an alternative to autologous grafts for tympanoplasty: a systematic review and meta-analysis. J Otolaryngol Head Neck Surg. 2021;50(1):xx.

Cho GW, Jang JH, Park YG, et al. Effect of growth factor-loaded acellular dermal matrix on tympanic membrane regeneration: experimental study. J Clin Med. 2021;10(7):1541.

Lajdam GB, et al. Comparison of temporalis muscle fascia and cartilage grafts for primary type I tympanoplasty: a meta-analysis of randomized controlled trials. Eur Arch Otorhinolaryngol. 2023;280(6):xxxx–xxxx.

Ferlito S, et al. Type I tympanoplasty outcomes between cartilage and temporalis fascia grafts: systematic review and meta-analysis. J Clin Med. 2022;11(23):7000.

Jain A, Parida PK, Singh PK, et al. Island cartilage vs temporalis fascia in type