Efficacy of Platelet-Rich Plasma in Endoscopic Sinus Surgery for Chronic Sinusitis: A Systematic Review and Meta-Analysis.

Chronic rhinosinusitis (CR) is a persistent inflammation of the nasal mucosa and paranasal sinuses. Endoscopic sinus surgery (ESS) is a procedure that improves sinus drainage and ventilation. Despite advancements in ESS, additional corrective procedures post-ESS are often needed. Clinical trials have explored the efficacy of platelet-rich plasma (PRP) as adjunctive therapy after ESS. This study aims to provide evidence supporting the efficacy of PRP post-ESS for CS patients. Independent authors searched three electronic databases (Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL)) and assessed the methodological quality of included studies using the Cochrane risk of bias 2 tool (RoB 2). Only randomized controlled trials (RCTs) were included. We pooled standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) using a random-effects model. Five RCTs met our inclusion criteria. Among 260 patients, 133 were allocated to PRP and 127 to the control group. PRP was associated with significantly lower postoperative nasal endoscopy scores (-1.74 (95% CI: -2.96, -0.52), P = 0.005) and Lund-Kennedy scores (-3.05 (95% CI: -4.97, -1.13), P = 0.002). PRP also significantly lowered Sinonasal Outcome Test-22 (SNOT-22) scores at one and three months follow-up (-8.25 (95% CI: -11.26, -5.24), P < 0.00001, and -2.75 (95% CI: -5.38, -0.12), P = 0.04, respectively). Subgroup analysis based on the location of administration showed borderline significance in the middle meatus group (-2.70 (95% CI: -5.35, -0.04), P = 0.05). This meta-analysis supports using PRP following ESS for CS patients. Despite promising results, further RCTs are needed to confirm long-term efficacy.