Platelet-Rich Concentrate for Tympanic Membrane Repair

Temporalis fascia myringoplasty (TFM) combined with a patient’s own platelet-rich concentrate (PRC) leads to better eardrum healing and hearing recovery than TFM alone, particularly for larger perforations. This conclusion comes from a comprehensive meta-analysis by Do Hyun Kim, David W. Jang, and Se Hwan Hwang, which examined 24 studies involving 1,669 patients with chronic otitis media.

How the Research Was Conducted

Kim, Jang, and Hwang conducted a systematic review and meta-analysis to compare two surgical approaches for repairing a perforated eardrum due to chronic infection. The intervention group underwent the standard TFM procedure—where tissue from the temple muscle is used as a graft—with the addition of a platelet-rich concentrate derived from the patient’s own blood. The control group received TFM alone.

The researchers searched five major medical databases: PubMed, SCOPUS, EMBASE, Web of Science, and the Cochrane Library. They focused on four primary outcomes: the success rate of complete tympanic membrane closure, the incidence of infection after surgery, changes in audiometric results (specifically air conduction thresholds and the air-bone gap), and the proportion of patients who gained more than 10 decibels of hearing. Using statistical models, they pooled data from the 24 included studies to determine the overall effect of adding PRC.

PRC Improves Healing and Hearing Outcomes

The combined data presents a clear advantage for the PRC group. The most fundamental measure of success—complete and intact healing of the eardrum—was significantly higher when platelet-rich concentrate was used. For patients and surgeons, a successful graft that remains closed is the primary goal, as a persistent perforation can lead to ongoing infection, discharge, and hearing loss.

Hearing improvements were also more substantial. The analysis found that patients who received PRC had greater gains in pure-tone air conduction thresholds and a larger reduction in their air-bone gap. This gap is a key indicator of conductive hearing loss caused by middle ear problems. Perhaps more telling, a higher percentage of patients in the PRC group achieved a postoperative auditory improvement exceeding 10 decibels, a change considered clinically significant in daily life.

The research also identified which patients benefit most. Subgroup analysis showed that the positive effects of PRC were particularly strong for medium and large tympanic membrane perforations. This suggests the growth factors and healing proteins in the concentrate provide critical support for repairing more challenging defects where graft failure risk is higher.

A Notable Reduction in Postoperative Infection

Beyond improving success rates, the PRC application offered a protective effect. The meta-analysis recorded a significantly lower incidence of postoperative infection in the intervention group. This is a critical practical finding. Postoperative infection can compromise the graft, lead to treatment failure, and require additional antibiotics or interventions. The inherent properties of platelet-rich plasma, which include antimicrobial and anti-inflammatory factors, likely contribute to this cleaner healing environment. This aligns with broader principles in hearing health where managing inflammation and infection is central to recovery, as discussed in our overview of hearing loss and associated conditions.

Practical Implications for Patients and Surgeons

This evidence supports the use of autologous PRC as a valuable adjunct in tympanoplasty surgery. For individuals facing surgery for a chronic eardrum perforation, particularly a larger one, this research indicates that a surgeon using PRC may improve the odds of a successful, infection-free outcome with better hearing recovery. The concentrate is autologous, meaning it is derived from the patient’s own blood, which minimizes any risk of rejection or allergic reaction.

For otologic surgeons, the study provides a strong evidence base for adopting or continuing this technique. The process of preparing PRC adds a step to the surgical procedure, but the meta-analysis suggests the benefits—higher closure rates, better audiometric results, and fewer infections—justify its use. It represents an optimization of an existing surgical method using the body’s natural healing mechanisms.

Successful middle ear surgery that restores a closed, healthy eardrum can have wide-ranging benefits. It can eliminate a chronic source of infection, improve conductive hearing loss, and may indirectly influence other auditory conditions. For instance, resolving underlying conductive pathology could potentially affect the perception of conditions like tinnitus and hyperacusis, though this requires specific study. Furthermore, improving hearing and reducing chronic ear disease can positively affect overall well-being and sleep, breaking cycles similar to the bidirectional link seen with tinnitus and sleep disturbance.

The study by Kim, Jang, and Hwang, available via DOI: 10.65717/iao.2026.252203, consolidates high-quality evidence that enhancing a standard surgical procedure with the patient’s own biology can lead to measurably better patient outcomes.