Otolaryngologists Are Cautiously Optimistic about Platelet-Rich Plasma But Want More Evidence

by Susan Bernstein •

Safety and Evidence Concerns

According to recent evidence, PRP therapy could improve wound healing and outcomes in cosmetic or reconstructive procedures. But otolaryngologic surgeons say safety concerns and a lack of research-based evidence remain hurdles to overcome before adopting it into wider use for their patients.

Rhinologist Zara M. Patel, MD, director of endoscopic skull base surgery at Stanford University School of Medicine in Stanford, Calif., has used PRP only in research settings because of the lack of robust evidence. “As a physician, I want more data so that I can be sure that any therapy is effective and worthwhile to use in a clinical setting,” she said. “PRP isn’t covered by insurance because it isn’t yet proven as effective in olfactory loss or other conditions.” (See the sidebar “Out of Pocket Costs,” below.)

Because PRP is an autologous blood product, some surgeons stress its safety, but questions remain, said Dr. Patel. She specifically wants more data on whether PRP, which upregulates various growth factors to stimulate stem cells and promote new tissue generation (Blood Res. 2016;51:3-5), could trigger tumors if injected into the nasal cavity, but noted that its other benefits look promising. “PRP can promote axon regeneration, where you actually regenerate nerve tissues to switch back on these disrupted neural connections,” she said. “It may have an anti-inflammatory effect and upregulate growth factors to regenerate these nerves.”

In addition, Dr. Epstein has a concern regarding its use in patients infected with the novel coronavirus. Hematology researchers recently published a study that shows that increased platelet activation is associated with poor outcomes in severe COVID-19 patients, and that hypercoagulability could result in thrombosis and death (Blood. 2020;136:1330-1341). Because COVID-19 is such a new infection, however, the pathophysiology behind hypercoagulability in patients isn’t well understood. “At this point, I’m recommending against PRP in patients who have had COVID-19 because of the risk of inducing a hypercoagulable state,” he said.

New Research

Research in PRP use in otolaryngology has been slow to develop, but it is becoming easier to find. A decade ago, Dr. Karimi attended a lecture on topical application of PRP after ablative laser procedures. “The speaker found that his patients had a lot of pain and needed a lot of time for healing. Anecdotally, they saw less pain and improvements in healing time with PRP,” he said. He reviewed literature on PRP at the time and found mostly opinion papers and non-randomized trials. “Now, there is more evidence on PRP use in otolaryngology and facial-plastic surgery. The strongest evidence on its use is in wound healing.”

Recent studies on PRP in otolaryngologic surgery are mostly small but show benefits: