Does platelet-rich fibrin improve outcomes in tympanoplasty for chronic tympanic membrane perforation? A systematic review and meta-analysis

Abstract Background This study aimed to systematically review and analyse the effectiveness of PRF in tympanoplasty for patients with chronic tympanic membrane perforation. Methods A systematic search was conducted in PubMed, Cochrane, and Scopus for studies published up to August 2025, adhering to PRISMA 2020 guidelines. The effect sizes were reported as odds ratios (OR) for binary outcomes and as standardized mean differences (SMDs) for continuous outcomes. We measured graft uptake as the primary outcome, and postoperative infection and hearing improvement as secondary outcomes. The risk of bias was assessed using RoB 2.0 and ROBINS-I. Results Ten studies comprising 708 patients (480 from six RCTs and 228 from four observational studies) included. For the primary outcome, PRF significantly increased graft uptake (OR = 3.97, 95% CI: 2.38–6.64, p < 0.0001) with consistent results across all follow-up periods. For secondary outcomes, the postoperative infection rate was significantly lower in the PRF group (OR = 0.18, 95% CI: 0.08–0.42, p < 0.0001) and the air-bone gap (ABG) improvement was also statistically significant (SMD = 0.44; 95% CI: 0.17–0.72; p = 0.0017). Conclusions Adjunction of PRF in tympanoplasty showed improved graft uptake, enhance hearing function and lower postoperative infection rates in chronic tympanic membrane perforations. These findings suggest that PRF may offer clinical benefits as an adjunct to tympanoplasty; however, further high-quality randomized controlled trials are warranted to strengthen the current evidence.