CSOM affects millions globally, with India showing high prevalence. It leads to persistent tympanic membrane perforation and hearing loss. While Type 1 tympanoplasty using temporalis fascia is standard, outcomes may vary due to tissue environment and healing capacity. Growth factor–rich PRF, a second-generation platelet concentrate, is emerging as an inexpensive, autologous adjunct with proven roles in wound healing. This study evaluates if autologous PRF added to routine tympanoplasty improves graft take and hearing gain.

Design, Setting: Prospective, randomized controlled trial at Alluri Sitarama Raju Academy of Medical Sciences, Eluru (July 2022 – June 2024). Participants: Inclusion: Age 12–45, inactive mucosal CSOM, dry ear ≥6 weeks, central perforation. Exclusion: Age <12 or >45, active infection, diabetes, atopy, immunosuppression, significant comorbidity. Randomization: • Group 1: Tympanoplasty with PRF (n=20) • Group 2: Tympanoplasty without PRF (n=20) Surgical Protocol: Underlay tympanoplasty via postauricular approach using temporalis fascia. PRF (10ml blood, 2,700 rpm, 12 min) prepared on-table and placed over fascia graft in Group 1; Group 2 received only gel foam. Outcomes: • Primary: Graft uptake at 3 months • Secondary: Hearing gain ≥10 dB at 3 months (pure tone audiometry, 500/1000/2000 Hz). Statistical Analysis: SPSS v20, chi-square for categorical data, p<0.05 significant. Ethics approval obtained, informed consent secured.

Table 1: Age and Gender Distribution Age Group (years) No. Patients % 11–20 1 2.5 21–30 10 25 31–40 7 17.5 41–45 22 55 Total 40 100 Gender Group 1 (PRF) Group 2 (No PRF) Total % Male 18 9 27 67.5 Female 2 11 13 32.5 Total 20 20 40 100 Laterality and Surgery Side Disease Laterality Group 1 (PRF) Group 2 (No PRF) Total % Unilateral 14 15 29 72.5 Bilateral 6 5 11 27.5 Total 20 20 40 100 Surgery Side Group 1 (PRF) Group 2 (No PRF) Total % Right 12 11 23 57.5 Left 8 9 17 42.5 Total 20 20 40 100 Perforation and Hearing Loss Table 2: Size of Perforation Size Group 1 (PRF) Group 2 (No PRF) % by group Small 2 4 10/20 Medium 7 5 35/25 Large 11 11 55/55 Total 20 20 100/100 Table 3: Degree of Hearing Loss Degree Group 1 (PRF) Group 2 (No PRF) Total % Mild 11 8 19 47.5 Moderate 9 12 21 52.5 Severe 0 0 0 0 Total 20 20 40 100 All operations ere performed under general anesthesia Key Outcomes Table 4: Graft Uptake Status Graft Status Group 1 (PRF) Group 2 (No PRF) p-value Significant? Success 20 (100%) 16 (80%) 0.03 Yes Failure 0 4 (20%) Total 20 20 40 Table 5: Audiological Benefit Audiological Gain ≥10dB Group 1 (PRF) Group 2 (No PRF) p-value Present 18 (90%) 14 (70%) 0.236 Absent 2 (10%) 6 (30%) Total 20 (100%) 20 (100%) No intra/postoperative complications or adverse reactions to PRF were observed in either group.

19 This study demonstrates that PRF significantly improves graft uptake in Type 1 tympanoplasty. The finding is congruent with other studies (Aboelnaga et al., Nair et al., Shetty et al.), each showing improved tissue healing and graft take rates with PRF. The present work showed 100% closure at 3 months among PRF recipients, compared to 80% in controls (p = 0.03). PRF’s autologous growth factors likely drive angiogenesis and epithelialization, with minimal risk and no additional cost except for lab preparation. Audiological improvement (≥10 dB) also trended higher with PRF (90% vs. 70%); though not statistically significant, it aligns with the better graft uptake observed. There were no PRF-related adverse effects or wound infections. This supports PRF’s safety and practical ease of integration into standard tympanoplasty workflows. Limitations: modest sample size, 3-month follow-up, and lack of granular analysis by perforation size or site. Larger, multicenter studies are recommended.

Incorporating autologous PRF in Type 1 tympanoplasty for CSOM yields significantly higher graft uptake rates, trends toward improved hearing gain, and does so with excellent safety and cost-effectiveness. PRF should be considered a standard adjunct in myringoplasty, especially where tissue healing is a concern.

1. World Health Organization. Chronic Suppurative Otitis Media: Burden of Illness and Management Options. Geneva: WHO; 2004. 2. Turhal G, Damar M, Sener E. Evaluation of PRF as packing material in type 1 tympanoplasty: a prospective controlled study. Am J Otolaryngol. 2022;43(3):103438. 3. Nair NP, Alexander A, Abhishekh B, et al. Safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty: a randomized controlled trial. Int Arch Otorhinolaryngol. 2019;23(01):077-82. 4. Mohamed Hosam, Shaker M, Aboulwafa A. Effect of topical use of platelet-rich fibrin in repairing central tympanic membrane perforation using endoscopic inlay butterfly cartilage myringoplasty. Egyptian J Otolaryngol. 2017;33:557–563. 5. Aboelnaga HA et al. Evaluation of the use of autologous platelet-rich fibrin in myringoplasty operation. Egyptian J Otolaryngol. 2022;38:142. 6. Shetty N et al. Topical use of autologous platelet-rich fibrin in tympanoplasty: A prospective interventional study. J Clin Diagn Res. 2022;16(6):MC01-MC04. 7. El-Anwar MW, El-Ahl MA, Zidan AA, Yacoup MA. Topical use of autologous platelet rich plasma in myringoplasty. Auris Nasus Larynx. 2015 Oct 1;42(5):365-8. 8. Habesoglu M, Oysu C, Sahin S, Sahin-Yilmaz A, Korkmaz D, Tosun A, Karaaslan A. Platelet-rich fibrin plays a role on healing of acute-traumatic ear drum perforation. Journal of Craniofacial Surgery. 2014 Nov 1;25(6):2056-8. 9. Lyngdoh NC, Saha R, Kamgo L, Gumeshwari. Platelet Rich Plasma Enriched Fat Myringoplasty: An Office Procedure for Repairing Small Tympanic Membrane Perforations. IOSR Journal of Dental Science and Medical Science. 2019 Mar 18(3):30-38. 10. Salaheldin AH, Hussein A. Effect of platelet-rich plasma on nasal mucociliary clearance after submucous diathermy of inferior turbinate. Egypt J Ear Nose Throat Allied Sci 2012;13:71-5. 11. Cumming’s Otolaryngology Head and Neck Surgery – 5th edition – volume 2 (see reference 17 in thesis for chronic otitis media). 12. Bajpai S. Study on Use of Platelet-Rich Plasma in Myringoplasty. Annals of Otology and Neurotology, 2 (1): 14-15. 2019. 13. Olusanya BO, Davis AC, Hoffman HJ. Hearing loss grades and the International classification of functioning, disability and health. Bull World Health Organ. 20 Oct 1;97(10):725-728.