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

In 2017, Yael Bensoussan, MD, an otolaryngology fellow at the University of Southern California Keck School of Medicine in Los Angeles, attended a lecture on platelet-rich plasma (PRP) injections in the larynx. Dr. Bensoussan, who was in medical school in Canada at the time, noticed that PRP was used by oral-maxillofacial surgeons to optimize healing after dental implant surgery and in plastic surgery but was rarely used by otolaryngologists. To find out why, she co-led a survey of Canadian otolaryngologists and maxillofacial surgeons to learn if and how they used autologous platelet products.

“The results of our survey showed that only 14% of the OTO-HNS respondents were using PRP, compared to 30% of oral-maxillofacial surgeons. Interestingly, most otolaryngologists said they weren’t using it due to lack of information about the product,” she said.

Now, three years later, Dr. Bensoussan is starting to see more evidence in the otolaryngology literature that autologous platelet products can be effective in promoting healing for procedures such as tympanoplasties, facial rejuvenation, and hair transplantation, as well as myringoplasty. Most published, high-quality evidence on PRP in otolaryngology is from animal studies, with results showing that PRP increases growth factors to promote healing in scars up to 14 days after injection, she said.

To perform PRP therapy, surgeons must draw a patient’s blood and spin it in a centrifuge to extract the platelet-rich portion, which can take up to 30 minutes. The injected, enriched blood must contain 250,000 platelets per milliliter, according to current standards approved by the U.S. FDA. There are many different PRP kits and systems available, so the final concentration of platelets, as well as leukocytes and growth factors, may vary. “There’s more unknown about this biologic modality than there is known, including the ideal concentration of platelets and the frequency of treatment,” said Jeffrey Epstein, MD, a private practice otolaryngologist in Miami and New York City.

Another, newer autologous platelet product is platelet-rich fibrin (PRF). With PRF, the patient’s blood is spun in the centrifuge at a lower speed so that platelets aren’t stripped of their fibrin, and it has no anticoagulants, said Los Angeles facial-plastic surgeon Kian Karimi, MD, who is the medical director for CosmoFrance, a manufacturer of a PRF system. PRF forms a smooth gel that holds in place, while PRP remains liquid. “With PRF, there’s a slow release of growth factors over a longer period of time, almost like an extended-release capsule,” he said.