Platelet-Rich Fibrin Plays a Role on Healing of Acute-Traumatic Ear Drum Perforation

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

The preparation of autologous platelet and extracellular vesicle-rich plasma (PVRP) has been explored in many medical fields with the aim to benefit from its healing potential. In parallel, efforts are being invested to understand the function and dynamics of PVRP that is complex in its composition and interactions. Some clinical evidence reveals beneficial effects of PVRP, while some report that there were no effects. To optimize the preparation methods, functions and mechanisms of PVRP, its constituents should be better understood. With the intention to promote further studies of autologous therapeutic PVRP, we performed a review on some topics regarding PVRP composition, harvesting, assessment and preservation, and also on clinical experience following PVRP application in humans and animals. Besides the acknowledged actions of platelets, leukocytes and different molecules, we focus on extracellular vesicles that were found abundant in PVRP.

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 effectiveness and safety of growth factors in the treatment of tympanic membrane perforations: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

To determine the clinical efficacy and safety of growth factors in the treatment of tympanic membrane (TM) perforations from randomized controlled trials (RCTs).

METHODS

Databases, including PubMed, EMBASE, Cochrane library, Ebsco, Ovid, Scopus, and Web of Science, were searched for articles in any language about studies on the treatment of TM perforations with growth factors. Inclusion criteria were: (1) randomized controlled trials (RCTs); (2) only patients with TM perforations included; and (3) any kinds of growth factors or related products were used as an intervention. Exclusion criteria were: (1) study was not reported as a full paper, only as an abstract; (2) review studies and case reports; and (3) an inability to extract valid data. Outcomes of interest included perforation closure rate, closure time, hearing improvement, and complications.

RESULTS

Nineteen RCTs with a total of 1335 participants were included. Growth factors effectively increased the rate of perforation closure [risk ratio (RR): 1.21 95% confidence interval (1.12, 1.30), p < 0.01] and shortened closure time [mean difference (MD): - 16.71 (- 22.74, - 10.15), p < 0.01]. There was no significant difference in hearing improvement [MD: 0.10 (- 0.50, 0.70), p = 0.74] or complications [RR: 1.49 (0.96, 2.32), p = 0.07] between the growth factor intervention group and the control group.

CONCLUSION

Growth factors are effective and safe in the treatment of TM perforations. However, better designed clinical trials should be carried out in the future to obtain more robust findings about the effectiveness of growth factors in the treatment of TM perforations.

Novel Use of Platelet Rich Fibrin Membrane in Transcanal Myringoplasty: A Prospective Study

Being rich in growth factors platelet rich fibrin (PRF) has been used for decades for its healing properties in cosmetic surgeries but its use in transcanal myringoplasty is a novel approach that remains unexplored. In todays era of minimally invasive surgery not only does it provide as a great alternative to conventional myringoplasty but also outshines it. It reduces post operative pain, hospital stay and unlike the conventional technique that uses termporalis fascia as a graft material, PRF myringoplasty if required can be reperformed on the same patient multiple times with minimal risk. This procedure comes as a boon for patients with recurrent graft defects because after multiple revision surgeries, temporalis fascia can be deficient and other graft materials like cartilage/perichondrium or fascia lata etc. have to be harvested surgically for myringoplasty. In PRF myringoplasty there is no upper limit in the number of times the PRF membrane can be made and also it does not entail any surgical incision for graft harvest. A prospective study involving 41 patients was conducted at Netaji Subhash Chandra Bose Medical College, Jabalpur where in the tympanic membrane perforations were repaired using PRF membrane with a successful outcome in 85.4% of the patients included in this study.

Surgical outcomes of myringoplasty using platelet-rich plasma and evaluation of the outcome-associated factors

OBJECTIVE

Tympanic membrane perforations must be closed with surgery; however, most surgical procedures are considerably invasive in nature. The aim of this study was to evaluate the outcomes of minimally invasive myringoplasty using platelet-rich plasma (PRP) and an atelocollagen sponge for closure of chronic tympanic membrane perforations, as well as to identify the factors affecting the surgical outcome.

METHODS

The records of 118 patients who underwent surgical closure of chronic tympanic membrane perforation at an ear-nose-throat clinic were reviewed retrospectively. After removing the margin of the perforation via a transcanal approach under local anesthesia, an atelocollagen sponge injected with PRP was inserted into the perforation as a scaffold. If the size of the perforation decreased after the surgery, the same surgical procedure was repeated. The success rate of closure after the last surgery was evaluated in terms of the size of the perforation. In addition, the relationships of the success rate with the cause and duration of perforation and patient age were also examined.

RESULTS

The perforation was closed after initial or repeat surgeries in 95.8% (68/71) of cases with small-sized perforations, 80.0% (32/40) of cases with middle-sized perforations, and 85.7% (6/7) of cases with large-sized perforations. Multiple surgeries (up to four times) were required for middle- and large-sized perforations, and even for some small-sized perforations. The number of re-operations required for closure significantly increased with increase in the size of the perforation (Kruskal-Wallis test, p<0.01). The cause and duration of perforation were not predictors of the surgical outcome. However, patient age was a significant predictor of the surgical outcome; patients older than 80years had a significantly worse success rate than younger patients (Fisher's exact test, p<0.01).

CONCLUSION

Minimally invasive myringoplasty using PRP has a satisfactory success rate even for large-sized tympanic membrane perforations. PRP is autologous and its use is non-toxic and safe. Although informed consent from the patient is necessary for the repetition of the surgery and for patients older than 80years, this technique appears to be a promising office-based procedure for closure of chronic tympanic membrane perforations.

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.

Application of Platelet Rich Fibrin Matrix to Repair Traumatic Tympanic Membrane Perforations: A Pilot Study

Trauma in the form of instrumentation, slap, blast, accident, and sporting injury can result in tympanic membrane (TM) perforations which spontaneously recover in 53-94%. The closure rates of TM perforation due to above causes do not vary greatly; however, some otolaryngologists prefer to perform immediate microsurgical procedures to accelerate the recovery process. Our aim is to study the efficacy of Trichloroacetic acid (TCA) Chemical Cauterization (50%) and Platelet rich fibrin (PRF) Plug Myringoplasty technique in healing traumatic tympanic membrane perforations. To evaluate the preoperative and postoperative hearing outcome from the procedure and compare them. Study design is prospective study. A pilot study was carried out amongst selected 25 patients with central perforations in the Department of ENT, for duration of 2 years from July 13 to July 15. All 25 patients underwent PTA assessment & TCA (50%) and Autologous PRF Plug Myringoplasty technique done and follow up to 6 months postoperatively. The success rate traumatic tympanic membrane closure was found to be 92%. Pre- and post-operative hearing assessments of each patient were done & showed statistically significant air-bone gap closure with success rate of 88% (p < 0.05). From this study, the closure rate in traumatic tympanic membrane perforation by TCA (50%) and PRF Plug Myringoplasty technique was 92% with statistically significant hearing improvement (88%). This technique can be recommended as a time and cost effective office based procedure for treatment of traumatic tympanic membrane perforations.

Assessment and spontaneous healing outcomes of traumatic eardrum perforation with bleeding

OBJECTIVE

This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs).

STUDY DESIGN

A case series with chart review.

SETTING

A tertiary university hospital.

MATERIALS AND METHODS

The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t-test.

RESULTS

One-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P>0.05). However, the average closure time differed significantly between the two groups (P<0.05): 29.4±3.7days for perforations without bleeding and 20.6±9.2days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P<0.01) within 2weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P>0.05) between the groups without and with bleeding within 4weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P=0.0).

CONCLUSION

This study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs.

Platelet-Rich Fibrin and Soft Tissue Wound Healing: A Systematic Review

The growing multidisciplinary field of tissue engineering aims at predictably regenerating, enhancing, or replacing damaged or missing tissues for a variety of conditions caused by trauma, disease, and old age. One area of research that has gained tremendous awareness in recent years is that of platelet-rich fibrin (PRF), which has been utilized across a wide variety of medical fields for the regeneration of soft tissues. This systematic review gathered all the currently available in vitro, in vivo, and clinical literature utilizing PRF for soft tissue regeneration, augmentation, and/or wound healing. In total, 164 publications met the original search criteria, with a total of 48 publications meeting inclusion criteria (kappa score = 94%). These studies were divided into 7 in vitro, 11 in vivo, and 31 clinical studies. In summary, 6 out of 7 (85.7%) and 11 out of 11 (100%) of the in vitro and in vivo studies, respectively, demonstrated a statistically significant advantage for combining PRF to their regenerative therapies. Out of the remaining 31 clinical studies, a total of 8 reported the effects of PRF in a randomized clinical trial, with 5 additional studies (13 total) reporting appropriate controls. In those clinical studies, 9 out of the 13 studies (69.2%) demonstrated a statistically relevant positive outcome for the primary endpoints measured. In total, 18 studies (58% of clinical studies) reported positive wound-healing events associated with the use of PRF, despite using controls. Furthermore, 27 of the 31 clinical studies (87%) supported the use of PRF for soft tissue regeneration and wound healing for a variety of procedures in medicine and dentistry. In conclusion, the results from the present systematic review highlight the positive effects of PRF on wound healing after regenerative therapy for the management of various soft tissue defects found in medicine and dentistry.

Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study

OBJECTIVES

(1) To evaluate the effects of a platelet-rich fibrin (PRF) membrane in the repair of traumatic tympanic membrane (TM) perforations; and (2) to compare the use of a PRF membrane with the paper patch technique with regard to recovery rates, healing time, and correction of the mean air-bone gap.

METHODS

A randomized, prospective analysis was performed for 60 patients who were treated for traumatic TM perforations using one of the two methods. Closure rate, speed of healing, and hearing gain were compared between the PRF (Group 1) and paper patch (Group 2) groups.

RESULTS

Closure was obtained in 28 (93%) perforations in Group 1 and 25 (83%) perforations in Group 2 (p > 0.05). On day 10, full closure of the TM was observed in 24 (80%) patients in Group 1 and 16 (53%) patients in Group 2 (p < 0.05). The improvement in the mean air-bone gap was 14.1 dB in Group 1 and 12.4 dB in Group 2 on post-operative day 45 (p < 0.05).

CONCLUSIONS

In comparison with the paper patch method, PRF, a new method, provided more rapid healing with more successful audiological results, and with no requirement for a second procedure.