Effect of platelet-rich plasma on recurrence of sinonasal polyps after endoscopic sinus surgery: a randomized clinical trial

Abstract

Background Chronic rhinosinusitis with nasal polyps (CRSwNP) is a persistent inflammatory condition that often requires surgical intervention. Despite advances in endoscopic sinus surgery (ESS), recurrence rates remain significant. Platelet-rich plasma (PRP), known for its regenerative properties, has been suggested to reduce inflammation and promote healing. Methodology This prospective randomized controlled clinical trial was carried out on 40 patients which aims to evaluate the effectiveness of PRP in reducing the recurrence and healing of sinonasal polyps after functional endoscopic sinus surgery (FESS) after 6 months follow-up. Patients aged over 18 years and under 60 years old, with more than 3 months of CRS symptoms with endoscopic evidence of polyps and/or mucosal changes on a CT scan were included in our study. Previous sinus surgery, systemic vasculitis, immune deficiency, allergic fungal rhinosinusitis, patients with uncontrolled systemic diseases or coagulopathy, history of asthma, aspirin sensitivity, cystic fibrosis, and congenital mucociliary problems were excluded from our study. Results Both groups showed improvement in Lund-Kennedy scores and SNOT-22 scores postoperatively. However, Group 1 demonstrated significantly greater improvement at 3 months (median Lund-Kennedy score: 4.0 vs. 6.0, p < 0.001) and 6 months (median Lund-Kennedy score: 4.5 vs. 6.0, p < 0.001) compared to Group 2. Additionally, the percent change in Lund-Kennedy scores was significantly higher in Group 1 (median 40.18% vs. 14.29%, p < 0.001). Group 1 also exhibited a substantial reduction in SNOT-22 scores at 6 months (median score: 7.0 vs. 45.0, p < 0.001) with a higher median percent change (90.91% vs. 43.65%, p < 0.001). Notably, relapse rates were lower in Group 1 (15.0%) compared to Group 2 (50.0%) at 6 months (p = 0.018). Conclusions PRP injection during FESS significantly reduces the recurrence of sinonasal polyps and improves clinical outcomes in patients with CRSwNP. These findings suggest PRP as a promising adjunctive treatment to enhance surgical outcomes and reduce healthcare burdens associated with recurrent sinonasal polyposis.