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

Abstract

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.

The possible mechanism of Hippophae fructus oil applied in tympanic membrane repair identified based on network pharmacology and molecular docking

“… 2 , 3 With the development of tissue engineering, various bioactive materials (e.g., growth factors) have been used as a replacement to conventional tympanoplasty in the treatment of simple TM perforations with great success rates. 1 , 2 , 3 , 4 , 5 , 6 , 7 However, these molecules have their own limitations, such as otorrhea caused by a high dosage of growth factors, and an ideal bioactive material has not yet been identified. 2 , 7 In traditional Chinese medicine, doctors use Chinese herbs to repair TM perforations, and these herbs have been reported to accelerate the wound healing process.…”

“…Patients who undergo tympanoplasty may suffer from pain and potential postoperative complications and might incur high medical costs 3,4 . For simple perforations without other middle ear disorders (e.g., cholesteatoma), an alternative to rupture closure that is less invasive and expensive is preferable to surgical intervention 5‐7 …”

“… 3 , 4 For simple perforations without other middle ear disorders (e.g., cholesteatoma), an alternative to rupture closure that is less invasive and expensive is preferable to surgical intervention. 5 , 6 , 7 …”

Autologous Platelet and Extracellular Vesicle-Rich Plasma as Therapeutic Fluid: A Review

“…The suggested benefit of PVRP, applied in animal and human, is in accelerating the healing and preventing dehydration of perforation margins [ 226 , 227 ]. A review of published articles on the topic has been done by Huang et al, who reported 93.4% of complete closure cases in patients that received PVRP after the surgery compared to 78.6% complete closure cases in patients that had surgery alone, with low incidence of complications [ 228 ]. In one case, graft rejection was reported in a patient with surgical repair failure.…”

Comparison of the effect of Triticum Vulgare and Hyperici Oleum on healing in traumatic membrane perforation: an animal study

“…Traumatic TM perforations are considered acute perforations that may to heal spontaneously; however, chronic perforations may develop as a secondary progression to the trauma. For such perforations, spontaneous healing could not be observed and surgical intervention may be required [2].…”