Platelet-rich fibrin versus Gelfoam as external auditory canal packing in endoscopic tympanoplasty: a comparative clinical study.

BACKGROUND: Gelfoam is widely used for external auditory canal (EAC) packing in tympanoplasty but may cause foreign-body reactions and unpredictable dissolution. Platelet-rich fibrin (PRF) offers an autologous alternative; however, its use as an EAC packing material remains limited. This study compared PRF and Gelfoam as EAC packing materials, focusing on clinical behavior and postoperative handling. METHODS: This retrospective study analyzed 228 endoscopic tympanoplasty patients grouped by EAC packing material—Gelfoam (n = 119) or PRF (n = 109). Demographic and surgical variables and the dissolution and handling characteristics of the packing materials were recorded. PRF was prepared intraoperatively from autologous blood and applied as 2–4 mm fragments. Dissolution behavior was assessed by routine postoperative otoscopic examination based on clinical visual estimation at postoperative weeks 1 and 2. RESULTS: Dissolution patterns differed markedly between groups. Gelfoam remained clinically persistent at two weeks, whereas PRF showed partial clinical dissolution at week 1 (22.47%) and near-complete dissolution by week 2 (83.67%) (p < 0.001). All Gelfoam cases required mechanical removal, while none of the PRF cases required aspiration (p < 0.001). PRF residues were non-adherent and associated with smoother epithelial healing on clinical inspection. CONCLUSION: PRF is a safe and effective alternative to Gelfoam as an EAC packing material in tympanoplasty. Compared with Gelfoam, PRF demonstrated more predictable clinical dissolution, minimal adhesion to the canal, and eliminated the need for postoperative suctioning. Given the retrospective design, further prospective studies are warranted.