The effect of platelet-rich fibrin membrane on the repair of perforated tympanic membrane: an experimental study

Impact of titanium-prepared platelet-rich fibrin in type 1 fascia graft tympanoplasty on graft survival and hearing outcomes

Background

Type 1 fascia graft tympanoplasty (T1FGT) is the mainstay surgical approach for the treatment of tympanic membrane perforations. The most widely used graft material is temporal muscle fascia, and graft take rates are reported differently. The methods to enhance graft take are still being investigated. Aim: The aim of our study was to investigate the effect of titanium-prepared platelet-rich fibrin (T-PRF) on graft take and hearing outcomes in T1FGT.

Materials and Methods

Fifty-seven ears eligible for T1FGT were involved in the study and prospectively evaluated. T-PRF was applied with T1FGT in 27 ears. Thirty ears in the other group underwent only T1FGT. The patients underwent an otomicroscopic and audiometric examination in preoperative and postoperative 2nd week, 1st month, and 6th month. Both groups were evaluated in terms of hearing levels, infection, and graft take rates.

Results

Two patients in the T1FGT + T-PRF group and seven patients in the T1FGT group had postoperative perforation (graft take rate: 92.6% versus 76.7%). The graft take rate was found to be increased in the T-PRF group although the difference was not statistically significant. In the T1FGT group, the percentage of infection was higher than in the T1FGT + T-PRF group. When the preoperative and postoperative 6th-month audiometry was compared, a statistically significant hearing gain was obtained for both groups.

Conclusion

In the treatment of tympanic membrane perforations, T-PRF applied over the fascia graft was shown to increase graft take rates and decrease the probability of infection. Further studies with larger samples are needed to demonstrate the effects of PRF.

3D printing technology and applied materials in eardrum regeneration

Tympanic membrane perforation is a common condition in clinical otolaryngology. Although some eardrum patients can self-heal, a long period of non-healing perforation leads to persistent otitis media, conductive deafness, and poor quality of life. Tympanic membrane repair with autologous materials requires a second incision, and the sampling site may get infected. It is challenging to repair tympanic membranes while maintaining high functionality, safety, affordability, and aesthetics. 3D bioprinting can be used to fabricate tissue patches with materials, factors, and cells in a design manner. This paper reviews 3D printing technology that is being used widely in recent years to construct eardrum stents and the utilized applied materials for tympanic membrane repair. The paper begins with an introduction of the physiological structure of the tympanic membrane, briefly reviews the current clinical method thereafter, highlights the recent 3D printing-related strategies in tympanic membrane repair, describes the materials and cells that might play an important role in 3D printing, and finally provides a perspective of this field.

Tympanic membrane regeneration using platelet-rich fibrin: a systematic review and meta-analysis

PURPOSE

Platelet-rich fibrin (PRF) results in satisfactory wound healing. This analysis focuses on assessing the effectiveness of PRF in the treatment of tympanic membrane (TM) perforations.

MATERIALS AND METHODS

The literature was searched using PubMed, Embase, Cochrane Library and Web of Science databases from inception to February 28th, 2021. The following healing and hearing outcomes were measured: closure rate, pre-and postoperative auditory results, and incidence of postoperative infections. Data were pooled and expressed as the odds ratio (OR).

RESULTS

Ten studies were eligible for qualitative review, and seven of them were included for the final quantitative comparison. The OR for the closure rate of acute perforations was 4.30 (95% CI 1.35-13.70, I² = 0%), and the OR in the chronic subgroup was 5.42 (95% CI 2.57-11.43, I² = 0%). The total OR value for the completed closure rate was 5.10 (95% CI 2.72-9.54, I² = 0%), indicating that the utilization of PRF can enhance the closure of both acute and chronic perforations. The qualitative review did not find improved hearing results with the use of PRF. In addition to promoting closure, PRF can reduce the incidence of infections (OR = 0.14). The sensitivity analysis did not change the final results, and there was no publication bias in this analysis.

CONCLUSION

PRF can increase the closure rate of acute perforations, enhance the survival rate of autografts in TM surgeries and reduce the incidence of infections. However, the literature indicates that PRF does not influence the hearing outcomes. This study shows that PRF is an effective agent for TM regeneration.

The impact of platelet-rich fibrin (PRF) on olfactory function and pain after septoplasty operations

BACKGROUND

We aimed to investigate the effect of platelet-rich fibrin (PRF) on olfactory function and pain score in patients who underwent septoplasty.

METHODS

This prospective randomized observational study was performed between 2018 January and 2019 April with 148 patients who had septoplasty operation. Patients were divided two groups and 74 patients were placed in group 1 to which PRF was applied after the completion of septoplasty whereas 67 patients were put in group 2 which did not undergo PRF. Sniffin' Sticks test was applied to all patients at pre-op, post-op 1-week, 6-week, and 6-month. Pain scores of patients were measured with visual analogue scale at 1 and 3 week.

RESULTS

The distribution of patients according to pre-op olfactory function (normo-hypo-anosmia), there was no significant differences statistically (p > 0.05). When we compared the 1-week post-op results of Sniffin' Sticks test of patients, we found differences between the groups (p < 0.05). It was observed in the early postoperative period that according to the Sniffin' Sticks test scores, the results of the PRF group were better than those of the non-PRF group. At 6-week and 6-month, between the groups; there was no differences in terms of olfactory function. When we looked at the pain score of patients at 1 and 3 week after septoplasty; significant differences were obtained between groups.

CONCLUSION

The application of PRF to the mucosal surface after the completion of septoplasty, has positive effect on olfactory function and pain especially in the early postoperative period. During the healing process, it was observed that prf maintained better odor functions. It is a minimally invasive technique with low risks and satisfactory clinical results.

Platelet-derived bio-products: Classification update, applications, concerns and new perspectives

Platelet derived bio-products in the form of platelet rich plasma, plasma rich in growth factors, or plasma-free platelet releasates, are being studied worldwide with the aim of proving their efficacy in tissue regeneration within many different clinical areas, such as traumatology, maxillofacial surgery, ophthalmology, dermatology and otorhinolaryngology, amongst others. The current lack of consensus in the preparation method and application form, or in the quality assessment of each bio-product, precludes adequate interpretation of the relevance of reported clinical outcomes, and, while many in clinicians are very positive about them, many are sceptic. Relevant aspects of these products are considered to propose a classification nomenclature which would aid a comprehensive comparison of clinical outcomes of bio-products of the same characteristics. Finally, the uses of platelet-derived bio-products in in vitro culture (for cell therapy purposes) as a substitute of animal-origin sera, and other future perspectives of applications of platelet-derived bio-products are discussed.

Impact of platelet-rich fibrin therapy in tympanoplasty type 1 surgery on graft survival and frequency-specific hearing outcomes: a retrospective analysis in patients with tympanic membrane perforation due to chronic otitis media

OBJECTIVE

To evaluate the impact of platelet-rich fibrin therapy in tympanoplasty type 1 surgery on graft survival and frequency-specific hearing outcomes.

METHODS

Patients who underwent tympanoplasty type 1 surgery were randomised into temporal fascia graft alone (n = 55) and temporal fascia graft plus platelet-rich fibrin therapy (n = 36) groups. Graft survival and hearing outcomes were recorded.

RESULTS

Graft survival rates were significantly higher in the temporal fascia graft plus platelet-rich fibrin therapy group than in the temporal fascia graft alone group at one (100.0 vs 85.5 per cent, p = 0.020), three (97.2 vs 80.0 per cent, p = 0.024) and six months post-operatively (94.4 vs 74.5 per cent, p = 0.031). The difference in hearing gain between groups was not significant.

CONCLUSION

Our findings revealed that the use of a platelet-rich fibrin plus temporal fascia graft for type 1 tympanoplasty was associated with more favourable post-operative outcomes than the use of temporal fascia alone, both in terms of tympanic membrane healing and graft survival; hearing restoration outcomes were similar.

A Novel Method of Obtaining Platelet Rich Fibrin from Rats and Quantifying Platelet Count

Background and objectives: Rat experimentation is the first line of research by which a medical hypothesis is usually tested. Platelet Rich Fibrin (PRF) is a relatively new bio-material that has shown promise to enhance healing in the field of bone research and tissue engineering. In order to perform PRF based experiments on rats, a proper protocol of obtaining PRF from rats needs to be established. Materials and Methods: 35 Wistar rats were used to obtain PRF by using cardiac puncture blood draw and quick subsequent centrifugation. The PRF samples wereanalyzed and compared to standard literature PRF composition. Results: PRF samples analysis showed persistent results pertaining to known PRF composition. Conclusions: Our experiment has shown that our protocol of obtaining PRF is capable of providing high quality PRF from rats.

A novel gel patch for minimally invasive repair of tympanic membrane perforations

OBJECTIVE

Evaluate the efficacy of a photocrosslinkable gel patch for repairing tympanic membrane (TM) perforations using a minimally invasive procedure.

METHODS

38 adult male chinchillas underwent bilateral TM perforation via CO₂ laser (n = 76 TMs). Eight weeks post-perforation induction, either a gel patch (n = 26) or EpiDisc (n = 12) was applied to the perforation through the ear canal. Perforation margins were not abraded prior to gel patch application in order to make the procedure minimally invasive. During the study, the application process was refined, and 9 of 26 gel-treated TMs received a second gel-patch augmentation. Perforations were observed for 14 weeks post-treatment to determine healing rates, after which animals were euthanized and their TMs and cochlea removed for histological analysis.

RESULTS

38 perforations (50%) persisted for 8 weeks without manipulation. Healing rates stabilized within three weeks post-treatment. Of the gel-treated TMs, 14 TMs healed after one application, 7 TMs healed after a second application, and 5 TMs did not heal, yielding an 81% total healing rate. Six of 12 EpiDisc-treated TMs healed (50%). There was no statistical difference (p = 0.06) in perforation size between gel-treated (25.1 ± 12.5% total TM area) and Epidisc-treated (36.4 ± 22.5). The largest perforation healed with gel patch was 60% total TM area. Histological analysis showed gel-treated TMs to have trilaminar regeneration with substantial lamina propria thickness. Gel-treated TMs had thickness of statistical equivalence to untreated TMs (47.1 ± 29.0 and 54.8 ± 12.1 μm, respectively (p = 0.40)). EpiDisc-treated TMs showed a cell monolayer of substantially less thickness (9.04 ± 6.26 μm, p < 0.05) than gel-treated TMs. No evidence of ototoxicity was present in cochlea from either gel patch or Epidisc treatment.

CONCLUSIONS

The gel is promising regarding thickness and trilaminar regenerated tissue, perhaps due to the biomechanical properties of the gel, and further refinements in the material and technique are anticipated to increase ease and efficacy of treatment while minimizing complications.

Safety and Efficacy of Autologous Platelet-rich Fibrin on Graft Uptake in Myringoplasty: A Randomized Controlled Trial

Introduction  Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing. Objectives  To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty. Methods  Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with platelet-rich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer. Results  A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group ( p  = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group ( p  = 0.012). The results were found to be statistically significant. Conclusion  Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which platelet-rich fibrin was used. The postoperative infection rate was also lower in the same group.