The effectiveness and safety of combining platelet-rich plasma with cartilage tympanoplasty type 1 to treat tympanic membrane perforations: a systematic review and meta-analysis.

PURPOSE: We evaluated the effectiveness of cartilage tympanoplasty type 1 combined with platelet-rich plasma (PRP) compared to cartilage tympanoplasty type 1 alone in dry tympanic membrane (TM) perforation due to chronic otitis media, demonstrating the safety and efficacy of PRP in tissue repair and regeneration.

METHODS

Data were retrieved from the literature up to April 2025. Outcomes of interest were success rate (complete closure of the TM postoperatively), postoperative air-conduction (AC) threshold, and changes in air-bone gap (ABG) and AC threshold (preoperatively to postoperatively). Pooled effects were calculated using standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

PRP-augmented cartilage tympanoplasty type 1 significantly improved ABG and AC compared to cartilage tympanoplasty type 1 alone (SMD 0.4517; 95% CI [0.1010; 0.8025], I2 = 0.0%) and AC (SMD 0.6193, 95% CI [0.2088; 1.0297]; I2 = 0.0%), and postoperative AC thresholds were significantly lower (SMD - 0.6194, 95% CI [- 0.9810; -0.2577]; I2 = 22.7%). The success rate of cartilage tympanoplasty type 1 with PRP significantly increased compared to cartilage tympanoplasty type 1 alone (OR 6.8721; 95% CI [3.2868; 14.3683], I2 = 0.0%) and combination therapy resulted in superior outcomes in all follow-up periods. PRP significantly reduced postoperative infection rates, but there was no significant difference in infection incidence between the two groups (OR 0.1843, 95% CI [0.0208; 1.6359]; I2 = 0.0%).

CONCLUSION

The autologous PRP application during cartilage tympanoplasty type 1 leads to higher success rates and greater hearing improvement, and also increases the success rate during all follow-up periods.