Efficacy and safety of fat graft myringoplasty combined with platelet-rich plasma for managing chronic tympanic membrane perforations: A systemic review and meta-analysis.

Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the process of gradient density centrifugation. Autologous PRP has been shown to be safe and effective in promoting natural wound healing processes. This study assessed the efficacy of fat graft myringoplasty combined with PRP in tympanic membrane (TM) healing in dry TM perforation due to chronic otitis media and compared it to that of fat graft myringoplasty. A systematic review and meta-analysis of prospective or retrospective studies was conducted, with database searches performed through April 2025. The outcomes included the success rate (complete closure of the TM postoperatively) and changes in air-bone conduction gap (ABG) (preoperatively and postoperatively) in the audiogram. Five studies (n = 522) were included. Fat myringoplasty with PRP resulted in greater improvement in ABGs (SMD 0.3292, 95% confidence interval (CI) 0.1317; 0.5266) and higher success rates (odds ratio (OR) 3.1289, 95% CI 1.8816; 5.2028) compared to fat myringoplasty alone. In medium-sized perforations, combination therapy demonstrated superior outcomes in both success rate (success rate (OR 3.1790, 95% CI 1.8914; 5.3432) and ABG (SMD 0.3569, 95% CI 0.1278; 0.5860). However, no significant differences were observed in cases involving small perforations (success rate (OR 2.1538, 95% CI 0.1739; 26.6721) and changes in ABG (SMD 0.2490, 95% CI -0.1405; 0.6384)). Both liquid and gel PRP significantly improved ABGs and TM closure rates, with no significant difference between types. This study demonstrated a higher success rate and greater hearing improvement with PRP-assisted fat myringoplasty, especially in medium-sized perforations. Both liquid and gel PRP forms were effective, with no significant difference between them.