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Myringoplasty Using a Human Birth Tissue Allograft

This video demonstrates a myringoplasty procedure using Neox RT – a human birth tissue allograft – to repair a tympanic membrane perforation in a pediatric patient. We employ a “sandwich” technique, in which pieces of the allograft are placed both medial and lateral to the perforation. After partially filling the middle ear with dry, absorbable gelatin sponge, trimmed pieces of allograft are inserted sequentially in underlay and overlay fashion to remain medial and lateral to the perforation. Both the underlay and overlay pieces cover the perforation and overlap the native tympanic membrane around the perforation. More absorbable sponge is then inserted lateral to the graft to hold it in place against the tympanic membrane. Finally, antibiotic drops and bacitracin ointment are placed in the canal.

Birth tissue contains growth factors that stimulate epithelialization, as well as extracellular proteins in the basement membrane that furnish scaffolding material for wound repair. These properties make it a natural and appealing option to induce tympanic membrane regeneration and healing.
This procedure has been successfully employed for the repair of both small and large tympanic membrane perforations.
Acute or chronic middle ear disease could be potential contraindications to this procedure.
Prepare and drape the ear in standard fashion.
Audiogram; clinical inspection of the perforation to assess for external or middle ear disease.
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Myringoplasty with human birth tissue is an efficient, safe, and effective technique that can be an acceptable alternative to either traditional myringoplasty or tympanoplasty, offering reduced morbidity and operating time.
Usual risks of myringoplasty, including non-resolution of perforation, enlargement of perforation, and potential hearing loss. These can be assessed in postoperative clinic visits and audiograms.
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1. Harvinder S, Hassan S, Sidek DS, Hamzah M, Samsudin AR, Philip R. Underlay myringoplasty: comparison of human amniotic membrane to temporalis fascia graft. Med J Malaysia. 2005;60(5):585-589. 2. Fairbairn NG, Randolph MA, Redmond RW. The clinical applications of human amnion in plastic surgery. J Plast Reconstr Aesthet Surg. 2014;67(5):662-675. doi:10.1016/j.bjps.2014.01.031

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