Platelet-rich plasma/fibrin in otolaryngology: A systematic review of randomized and non-randomized studies

To systematically review the current evidence of Platelet-rich plasma (PRP) applications in otorhinolaryngology and evaluate treatment outcomes across different ENT pathologies.

PubMed, Scopus, and Cochrane databases.

A systematic literature search was conducted from inception to August 2025 with the PRISMA statements. Meta-analysis was not performed due to substantial protocol heterogeneity. Randomized controlled trials and observational studies investigating PRP use in ENT disorders were included. Risk of bias was assessed using the RoB2 tool for randomized trials. Data extraction focused on clinical outcomes, preparation protocols, and methodological quality.

Forty-two studies met inclusion criteria (31 RCTs (randomized controlled trials), six prospective controlled trials, four retrospective controlled studies, one prospective case series), accounting for 3197 patients. Applications included rhinology (n = 15), otology (n = 14), and laryngology/head-neck surgery (n = 13). 33 studies (78.6%) showed PRP was better than controls, while 9 studies (21.4%) showed no significant difference. The strongest evidence is for tympanic membrane perforation repair and olfactory dysfunction. Substantial protocol heterogeneity existed in blood volumes, anticoagulation methods, and centrifugation protocols. Only six studies (15.4%) reported platelet concentrations (3-10-fold baseline); none analyzed plasma composition. Bias assessment revealed 35.5% low-, 41.9% moderate-, and 22.6% high-risk RCTs, primarily due to inadequate blinding procedures (55.2% moderate/high risk) and outcome measurement issues (22.6% high risk).

PRP demonstrates promising efficacy in otolaryngology, particularly for tympanic membrane repair and olfactory dysfunction. Significant protocol heterogeneity and the absence of biological content analysis limit evidence quality and clinical standardization.