A recent systematic review and meta-analysis analyzed how platelet-rich plasma influenced endoscopic sinus surgery outcomes in patients with chronic sinusitis.

Though surgical outcomes vary, endoscopic sinus surgery (ESS) is an effective treatment option for patients with persistent chronic sinusitis. Using platelet-rich plasma (PRP) after surgery may improve these outcomes, according to a review in Clinical Otolaryngology.

Ebraheem Albazee, MD, and colleagues conducted a systematic review and meta-analysis of six randomized controlled studies (RCTs) to understand how PRP impacted ESS outcomes.

The researchers wrote that this is the first study to look at the role of PRP after ESS, which “is significant because it fills a crucial gap in the literature, potentially guiding clinical practice and future research.”

Determining Specific ESS Outcomes

ESS has been shown to increase precision and reduce surgical trauma, though there are barriers to its long-term effectiveness. PRP may eliminate some of those obstacles due to its high concentration of platelets, which help with tissue regeneration, wound healing, and inflammation modulation. PRP may also reduce the risk of persistent or recurrent sinus disease.

To evaluate PRP’s effectiveness, the researchers reviewed RCTs in which adult patients received PRPs after ESS for chronic sinusitis. To be included, the RCTs also had to feature PRP as an intervention after ESS and have a placebo/control group. Patient follow-up across the studies ranged from 1 week to 9 months after intervention.

Six RCTs involving 198 patients met the researchers’ requirements. The reviewers included four of those studies, totaling 169 patients, in the meta-analysis. Bias risk was high for two RCTs, low for three RCTs, and medium for one RCT.

The researchers examined PRP’s effectiveness based on three outcomes: postoperative nasal endoscopy scores (as calculated with Lund-Kennedy scores or Meltzer scores), olfactory sensation scores, and pre-operative anosmia duration.

The Impact of PRP

While the six included RCTs had the same aim, to assess PRP’s impact on patients with chronic sinusitis after ESS, variables such as administration method and sample size varied greatly.

There were several noteworthy differences between the studies, including:

• Sample size, (range 13 to 40)
• Placebo size (range, 13 to 40)
• Administration methods (irrigation, injection, or not reported)
• Administration site (middle meatus and ethmoid cavity, olfactory region, the surface where a polyp was removed, or middle meatus)
• Blood samples (10, 20, or 25 mL, with one study not reporting on this variable)
• PRP preparation technique (two-stage centriconfiguration or not reported)
• Nasal endoscopy assessment tool (Lund-Kennedy score, Meltzer score, or not reported)
• Olfactory sensation score tool (modified Sniffin’ Sticks Test, Iran Smell Identification Test, or not reported)

Across all studies, postoperative nasal endoscopy score was lower in the PRP group than the placebo or control, suggesting that PRP may support this surgical outcome. The researchers found no significant differences in olfactory sensation scores or pre-operative anosmia duration between the placebo groups and participants who received PRP.

However, the authors cited other studies where PRP did impact olfactory sensation scores and pre-operative anosmia duration in populations with other conditions. For example, one study cited by the researchers suggested PRP improves olfactory sensory scores in patients with COVID-19.

These results suggest PRP may not improve these two outcomes in populations with chronic sinusitis, but this cannot be definitively concluded due to a few study limitations. The researchers reported high levels of heterogeneity across the studies; they also did not account for factors like PRP administration techniques, PRP preparation techniques, patient characteristics, and different assessment tools, which may impact PRP’s impact on all three outcomes.

Areas for Future Study

While this study suggests PRP may have a useful impact on postoperative nasal endoscopy scores, the reviewers wrote that larger randomized trials with a lower likelihood of bias are needed. The studies also didn’t evaluate how the administration method or administration site influenced PRP’s effectiveness.

Other variables worth further investigation are how the length of the follow-up period influences PRP’s effectiveness, the best preparation techniques, the right PRP dosage, PRP administrative timing, and patient selection criteria.

There’s also room to compare PRP to platelet-rich fibrin (PRF). PRF is a more advanced form of PRP consisting of platelets, fibrin matrix, and leukocytes. While both might be useful in populations with chronic sinusitis, there is no direct comparison of the two to date.

Another key limitation of this current study is that 50% of the RCTs analyzed took place in Iran. Studies conducted in more countries with different patient populations may provide additional insight into PRP’s effectiveness.

Dr. Albazee and colleagues concluded that despite these limitations, the review’s results suggest PRP could enhance ESS surgical outcomes. They emphasized the need to explore how best to incorporate PRP into treatment plans for patients with chronic sinusitis.