Table 1.

Comparison between current surgical techniques and tissue engineering for the regeneration of the tympanic membrane.

Advantages	Disadvantages
Myringoplasty/Tympanoplasty
High success rate	Required anesthesia
Good outcome in small perforations	Greater surgery time
Minimally invasive technique	Open surgical procedure (associated risks)
Routine clinical practice	Incision to take the graft and remove squamous epithelium
	Limited availability of autologous graft in revision cases
	Failure of perforation closure due to the deficient regenerative activity at the edges of the injury
	Frequent re-perforation
	Bilaminar neomembrane: flaccid and acoustically suboptimal
	Side effects: retraction pockets, tympanosclerotic mass, rejection
Tissue engineering
Surgery simplification	Mostly animal studies (acute perforations, which would spontaneously close in most cases)
Cost savings
Improve outcome in chronic perforations	Lack of a standard animal model
Growth factors improve tympanic closure	Scarce human clinical trials
Specific design of scaffold materials that reproduce the mechanical properties of the eardrum	Possible side effects of scaffold materials, biomolecules and cells
	Ethical and legal issues concerning the use of xenografts
Possibility of generating a commercially available tympanic membrane	Complex manufacture of the artificial construct (storage, biopreservatives, quality controls, production and transportation costs)