Platelet-Rich Plasma in Fat Graft Type-1 Tympanoplasty - Should We or Should We Not?

Introduction  Fat grafts have been in used since 1962 for small central perforations, with a success rate ranging from 86 to 100%. Platelet-rich plasma (PRP) containing platelet concentrations greater than 1 million platelets/μL assist the healing process by various means. Current data suggests improved healing when tympanoplasty is performed using temporalis fascia grafts if PRP is added during surgery. Objective  To assess the effect of PRP on fat grafts in small and moderate-sized central perforations. Methods  The present prospective observational study was conducted with 36 patients who underwent fat graft tympanoplasty with PRP under local anesthesia. Clinical and audiological observations were carried out after 4, 8, and 12 weeks, and a statistical analysis of the observations was performed. Results  We assessed 23 patients with small central perforations and 11 patients with moderate central perforations. An overall success rate of 76.4% was observed, with an 82.6% success rate among patients with small central perforations and 63.6% among those with moderate central perforations. There was no statistically significant difference in the uptake regarding the location of the perforation, but a statistically significant difference was found in terms of hearing improvement following the procedure. Conclusion  The morbidity of conventional tympanoplasty in cases of small-to-moderate central perforations in patients with chronic otitis media vis a vis the results of the procedure needs to be revisited, as in the present study fat grafts placed with PRP under local anesthesia could lead to surgical and audiological outcomes that are as good as those reported in the literature.