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

by Susan Bernstein •

  • In a 2015 literature review of 47 studies of PRP, leukocyte-rich PRP and PRF in facial rejuvenation surgery, patient recovery, and wound healing after facial plastic surgery, results showed significant, measurable effects on cellular changes, wound healing, and aesthetic outcomes of these surgeries, including enhanced fat graft survival (Aesth Plast Surg. 2015;39:495-505).
  • In a 2016 prospective study from the United Arab Emirates, 38 patients who had open rhinoplasties with osteotomies (19 PRP, 19 controls) were followed for 90 days. In the PRP group, surgeons injected 1 ml of PRP under each eye and 2.5 ml into the subperichondrial septum, on the dorsum of the nose, at the sites of osteotomies, and at the columella around the open rhinoplasty wound. There was significant improvement in periorbital and nasal edema and less postoperative bleeding in the PRP group, but no significant differences between groups in postoperative bruising. PRP group patients were able to remove their nasal packing earlier due to less bleeding and edema (Otolaryngol (Sunnyvale). 2016;6:280).
  • A 2019 study from Japan evaluated 118 patients who had minimally invasive myringoplasty and surgical closure of chronic tympanic membrane perforations. Surgeons inserted an atelocollagen sponge injected with PRP into the perforations. They found that 98.5% of patients with small perforations, 80% with medium perforations, and 85.7% with large perforations achieved closure, although some required multiple surgeries. The study concluded that PRP was safe, satisfactory, and promising for promoting wound healing in office-based procedures (Auris Nasus Larynx. 2020;47(2):191-1970).
  • In February 2020, Dr. Patel co-authored a small, single-arm pilot safety study on one PRP injection into the nasal cavities of seven patients with olfactory dysfunction (Laryngoscope Investig Otolaryngol. 2020;5:187-193). Results showed that PRP was safe, and patients all noted some improvements in smell threshold, but benefits didn’t continue.

The results from Dr. Patel’s study were encouraging enough, however, to prompt a new clinical trial, which will recruit patients soon. (ClinicalTrials.gov Identifier NCT04406584). Patients will be randomized to receive either three 1 ml PRP or saline injections into the olfactory cleft every two weeks to see if a series of injections will trigger more sustained improvement. “We need to find more globally effective therapies to help the other 50% of patients who don’t respond to steroids or other treatments,” said Dr. Patel. “Their condition is very impactful on their quality of life. For some, their sense of smell never comes back.”

Dr. Bensoussan is working on a new trial led by Michael Johns, MD, and Karla O’Dell, MD, to test the effects of PRP injections into vocal fold scars (ClinicalTrials.gov Identifier NCT03749863). Surgical removal of these scars often worsens the condition, and the current standard of care is steroid injection.

“PRP is a promising approach. The goal is to soften the scar tissue to achieve better vibration of vocal cords and optimize the voice,” and PRP could represent an easy, low-risk alternative to current treatments, Dr. Bensoussan said. “For patients who use their voices every day, a vocal fold scar can cause strain and fatigue and have a significant impact on quality of life.”