Role of Platelet Rich Plasma in Tympanoplasty

Platelet Rich Products in Cleft Palate Repair

ObjectiveCleft palate (CP) is a common congenital malformation with numerous popular and effective techniques described for operative repair. Despite this, the fistula rate following primary as well as secondary palate repairs remains high with reports ranging between 15% and 55% fistula rate. We conducted a systematic meta-analysis review to evaluate the effect of platelet rich products (PRPs) on rate of fistula formation given its well documented association with accelerated wound healing.DesignMeta-analysis systematic review.SettingArticles identified through MEDLINE, Embase, Pubmed, Google Scholar, Web of Science, Scopus, Cochrane, References, related articles.Patients, ParticipantsPatients in randomized controlled trials undergoing primary or secondary CP repair.InterventionsPRP vs no PRP.Main Outcome MeasureRate of fistula formation.ResultsFive articles with a total of 164 patients were identified and included in our final meta-analysis. There were 82 patients in each experimental and control groups. A total 22 patients experienced a fistula. Fistula rates in PRP and non-PRP groups were 4.9% (n = 4) and 22.0% (n = 18). The difference of fistula rates between PRP and non-PRP groups was statistically significant (pooled risk ratio: 0.32 (0.12-0.82, p = .02) on our overall pooled meta-analysis.ConclusionIn our meta-analysis review, PRP was found to significantly reduce fistula rates after primary or secondary palatoplasty in CP repair. PRP may represent an effective intra-operative adjunct to conventional surgical management and repair of CP to reduce the risk of fistula formation. Further investigation is required to explore the impact of the use of PRP on other post-operative parameters for CP.

Platelet Concentrates Impact on Myringoplasty Outcomes in Chronic Otitis Media Patients: Systematic Review and Meta-analysis

OBJECTIVE

We aimed to perform a systematic review and meta-analysis of myringoplasty outcomes following platelet concentrates application in patients with chronic otitis media (COM).

DATA SOURCES

We searched MEDLINE, Embase, and Cochrane Central register of Controlled Clinical Trials (CENTRAL). We also performed a manual search in Google Scholar and reference lists.

REVIEW METHODS

Eligible for inclusion were randomized controlled trials on COM patients undergoing myringoplasty with platelet concentrates (platelet-rich plasma or platelet-rich fibrin) compared to myringoplasty alone. The primary outcomes were graft uptake and air-bone gap (ABG) gain, while the secondary outcome was complication rate. We used odds ratio (OR) and standardized mean difference (SMD) to represent dichotomous and continuous outcomes, respectively.

RESULTS

Thirteen trials (n = 1179) were deemed eligible. Platelet concentrates significantly improved graft uptake after 6 months (OR: 2.45, 95% confidence interval [CI]: 1.34-4.47, P = .004, I2 = 0%, high certainty), ABG gain (SMD: 0.36, 95% CI: 0.17-0.55, P = .0002, I2 = 0%, moderate certainty), and complication rate (OR: 0.38, 95% CI: 0.18-0.82, P = .01, I2 = 0%, low certainty).

CONCLUSION

Our results showed that platelet concentrates may improve graft uptake and ABG gain and reduce complications in COM patients undergoing myringoplasty. Caution is warranted given to the relatively small sample size, as well as inconsistent reporting across included trials.

The Role of Platelet-Rich Plasma in the Management of Sensorineural Hearing Loss: Current Evidence and Emerging Trends

Sensorineural hearing loss (SNHL) is a common form of hearing impairment characterized by damage to the inner ear or auditory nerve, resulting in significant communication difficulties and reduced quality of life. Current treatment options, including hearing aids, cochlear implants, and corticosteroids, primarily focus on symptom management and do not address the underlying pathophysiological damage. Platelet-rich plasma (PRP), an autologous concentrate rich in platelets and growth factors, has emerged as a potential regenerative therapy due to its ability to promote tissue repair and cellular regeneration. This review provides a comprehensive overview of the role of PRP in the management of SNHL, examining the current evidence from preclinical and clinical studies. We discuss the mechanisms through which PRP may promote auditory tissue regeneration and repair, analyze its efficacy and safety profile, and explore innovative approaches and future directions in its application for SNHL. Despite promising preliminary findings, further research is needed to optimize PRP protocols, establish standardized treatment guidelines, and conduct large-scale randomized controlled trials to validate efficacy. This review aims to highlight the potential of PRP as a novel therapeutic strategy in treating SNHL and its possible integration into current clinical practices, offering new hope for patients with this debilitating condition.

Comparative Study of Endoscopic Transcanal Tympanoplasty and Tympanoplasty by Conventional Postaural Approach in a Tertiary Care Hospital in Central India

Background Chronic otitis media (COM) often necessitates tympanoplasty to repair the tympanic membrane. While conventional postaural tympanoplasty (PA) is well-established, endoscopic transcanal tympanoplasty (ET) is gaining traction for its minimally invasive benefits. This study aims to compare these two surgical techniques regarding their anatomical and functional outcomes and assess the role of platelet-rich plasma (PRP) in improving these outcomes. Material and methods This prospective comparative study was conducted at Acharya Vinoba Bhave Rural Hospital, involving 60 patients with COM. Participants were randomly assigned to receive either ET or PA, with each group further subdivided based on PRP use. Preoperative evaluations included auditory function tests and diagnostic endoscopy. Postoperative assessments were performed at seven days, one month, and three months to evaluate graft acceptance and hearing improvement using pure tone audiometry (PTA). Statistical analyses included the chi-square test, t-test, ANOVA, and paired t-test. Results The study included patients with a mean age of 38.1 years, predominantly female (71.67%). ET demonstrated superior anatomical outcomes compared to PA, with higher graft acceptance rates and better hearing improvements. The average hearing gain was 10.4 dB in the ET group versus 8.1 dB in the PA group. PRP uses enhanced graft acceptance and hearing restoration across both surgical approaches, contributing to better overall outcomes. Conclusion ET offers significant advantages over conventional postaural tympanoplasty in terms of anatomical and functional results. PRP further improves surgical outcomes, making ET a preferable option for tympanoplasty in COM patients. These findings support the broader adoption of ET and PRP to enhance patient outcomes in tympanoplasty procedures.

The Impact of Topical Application of Platelet-Rich Fibrin on Graft Survival in Surgeries for Chronic Otitis Media

OBJECTIVE

This study aims to evaluate the efficacy of platelet-rich fibrin (PRF) application in tympanoplasty procedures for patients with chronic otitis media (COM), assessing its influence on graft survival and healing time.

METHODS

In this prospective interventional study, conducted between January 2022 and June 2023, 80 patients diagnosed with COM were enrolled and divided into two groups. Group A underwent standard tympanic membrane repair using temporal fascia grafts (TFG), while Group B received TFG with adjunctive PRF application. The patients were observed and assessed over a 20-week postoperative period.

RESULTS

The study showed a significant enhancement in graft survival rates in Group B (TFG+PRF), with only one residual perforation compared to seven in Group A (TFG alone) at 20 weeks (p=0.02534). Furthermore, Group B patients experienced faster healing, achieving 97.5% graft integrity at 10 and 20 weeks, in contrast to Group A's 87.5%.

CONCLUSION

The application of PRF in tympanoplasty procedures for COM notably enhances graft stability and expedites the healing process. These findings suggest that PRF can be a valuable adjunct in otolaryngological surgeries, offering potential improvements in patient outcomes and surgical efficacy.

[The use of autologous platelet-rich plasma in the treatment of chronic pharyngitis]

The results of a prospective open cohort study of the use of platelet-rich plasma (platelet-rich plasma - PRP) in patients with chronic pharyngitis during the exacerbation of the disease are presented.

OBJECTIVE

To evaluate the clinical efficacy of autologous PRP in the treatment of chronic pharyngitis.

MATERIAL AND METHODS

Autologous PRP was injected into the posterior pharyngeal wall as a course of endopharyngeal blockages as part of the complex therapy of chronic pharyngitis. Patients in the control group received standard therapy, without the use of autologous PRP. The effectiveness of the studied technique was evaluated by statistical analysis of the intensity of symptoms of the disease, determined by patients throughout the entire period of treatment in the patient's diary, as well as by analyzing data from mass spectrometry of microbial markers and bacteriological examination of the pharyngeal mucosa, collected at the beginning of the study and 14 days after completion of the course of therapy.

CONCLUSION

The use of a course of endopharyngeal blockades with autologous platelet-rich plasma as part of the complex therapy of chronic pharyngitis, according to our estimates, provides a significant effect in the form of higher rates of reduction in the severity of symptoms of the disease, a significant reduction in the number of microorganisms deviating from the reference values (by 2 times or more), a decrease in the duration of the disease compared with the control group.

Overcoming barriers: a review on innovations in drug delivery to the middle and inner ear

Despite significant advances in the development of therapeutics for hearing loss, drug delivery to the middle and inner ear remains a challenge. As conventional oral or intravascular administration are ineffective due to poor bioavailability and impermeability of the blood-labyrinth-barrier, localized delivery is becoming a preferable approach for certain drugs. Even then, localized delivery to the ear precludes continual drug delivery due to the invasive and potentially traumatic procedures required to access the middle and inner ear. To address this, the preclinical development of controlled release therapeutics and drug delivery devices have greatly advanced, with some now showing promise clinically. This review will discuss the existing challenges in drug development for treating the most prevalent and damaging hearing disorders, in particular otitis media, perforation of the tympanic membrane, cholesteatoma and sensorineural hearing loss. We will then address novel developments in drug delivery that address these including novel controlled release therapeutics such as hydrogel and nanotechnology and finally, novel device delivery approaches such as microfluidic systems and cochlear prosthesis-mediated delivery. The aim of this review is to investigate how drugs can reach the middle and inner ear more efficiently and how recent innovations could be applied in aiding drug delivery in certain pathologic contexts.

A Randomised Controlled Trial on the Efficacy of Topical Application of Autologous Platelet Rich Plasma (PRP) on Graft Uptake Rate in Adults Undergoing Type 1 Tympanoplasty for Inactive COM Mucosal Disease

To assess the efficacy of topical use of autologous platelet rich plasma (PRP) as a packing material in type 1 tympanoplasty in Mucosal Inactive COM disease by conducting a Randomized Controlled Trial in 80 patients. Prospective Randomized Controlled Trial. Total 80 patients were enrolled for the study after fulfilling the inclusion and exclusion criterion. Written and informed consent was taken from all patients. After taking detailed clinical history, the patients were divided in to two groups of 40 patients each by block randomization. Group A was the interventional group where topical autologous platelet rich plasma was applied on the graft during type1 tympanoplasty. In Group B, PRP not applied. Graft uptake rate was observed postoperatively after 1 month and 6 months. Successful graft uptake at 1st month was noted in 97.5% patients in Group A and 92.5% in Group B with a corresponding failure rate of 2.5% and 7.5% respectively. Successful graft uptake at 6th month was noted in 95% patients in Group A and 90% in Group B with a corresponding failure rate of 5% and 10% respectively. As observed from our study status of graft uptake and reperforations at 1st and 6th months subsequent to surgery and rate of post-operative infections were similar in both the groups irrespective of the status of receiving autologous platelet rich plasma. Trial registration Trial registered with CTRI (Clinical Trial Registry -India) (Reg. no CTRI/2019/02/017468 dated 05/02/2019).

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03681-w.

Comparative efficacy of platelet-rich plasma applied in myringoplasty: A systematic review and meta-analysis

BACKGROUND

Tympanic membrane (TM) perforation is quite common in the clinical setting. Chronic TM perforations require surgical treatments such as myringoplasty. Currently, platelet-rich plasma (PRP) is a novel, effective substance that is increasingly utilized for TM perforation repair. This study aims to evaluate the effectiveness of PRP in the application of TM perforation repair.

METHODS

A systematic search was conducted to screen the Medline, Embase, Cochrane, Scopus and Web of Science databases up to July 2020. Studies were identified in accordance with the selection criteria by two coauthors independently. Data regarding the healing and hearing outcomes were pooled and analyzed via Review Manager version 5.3 and STATA version 12.0 software. Odds ratio (OR) was utilized to compare the closure rate. Furthermore, the results of hearing improvements and incidence of complications were also compared to evaluate the effectiveness of PRP.

RESULTS

A total of eight studies with 455 participants were eligible according to the selection criteria. Compared to conventional surgery, the OR of closure was 2.70 (95% CI: 1.27 to 5.76, P = 0.01, I2 = 0%) in randomized controlled trial (RCT) subgroup and 6.18 (95% CI: 2.22 to 17.25, P = 0.0005, I2 = 0) in non-RCT subgroup. The overall OR of closure was 3.69 (95% CI: 2.02 to 6.74, P<0.0001, I2 = 0%), suggesting a significant effect on the healing of TM perforation. Between preoperative and postoperative hearing results, there is no statistical difference between the PRP and the control groups. Additionally, the use of PRP resulted in a lower incidence of complication than the use of conventional approaches.

CONCLUSION

The application of PRP during the TM surgeries can enhance the closure rate, provide similar hearing improvements and decrease the incidence of postoperative complications. Given these advantages, PRP can be considered an effective treatment for TM regeneration.