The care we provide to patients is ultimately about aiming for speedy recovery from their illness – this has been the case since time immemorial. There is no doubt that advances in medical and surgical care have been exponential since the days of Hippocrates in advancing this cause, however there are still bottlenecks experienced in recovery. One significant factor is the patient’s own physiology. This is clearly a double-edged sword; on the one hand, you have the vital role it plays in guiding natural healing processes, such as haemostasis, cellular proliferation and combating infection. On the flip side, the same immune-mediated responses can cause a delay in recovery. These concerns are magnified after surgical intervention and are clearly an issue given the multi-million-pound industry that has been developed to promote and speed up postoperative convalescence. The editors’ choice for this month is two journal reviews – both look at the role of regenerative medicine using autologous biological factors to promote healing and reduce inflammation. The first is a systematic review of the role of platelet rich plasma in improving olfactory dysfunction. The second is a meta-analysis of the role of autologous products in improving healing across a wide range of ENT conditions and procedures. As always in emerging fields of medicine, the reviews show some signs of positive benefit, but more study is clearly required. The benefits to individuals of using their own biological material makes absolute sense and evidence for this form of therapy in some musculoskeletal conditions, such as knee osteoarthritis, is gaining traction through robust level 1 evidence. Whether this translates into ENT practice long term remains to be seen, however the future does look promising. The editors would like to thank the reviewers for their continued and invaluable contributions.
– Nazia and Gaynor
Despite high standards laid for surgery and the input involved therein, outcomes can be variable. Not uncommonly, there is poor tissue regeneration resulting in failure of grafts. Inflammation continues, prolonging postoperative morbidity. This is a meta-analysis of 12 studies comparing the postsurgical progress in two groups of patients with and without use of additional substances that promote healing and reduce inflammation. The study is based on the concept that autologous platelet concentrates (APC), platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) accelerate graft uptake and promote epithelialisation through release of platelet-derived growth factor (PDGF) and transforming growth factor-beta1 (TGFbeta1). APC in particular has immuno-modulatory properties by balancing pro-inflammatory cytokines such as interleukin-6 (IL-6) and matrix metalloproteinases. Inflammation is therefore restricted. In these 12 prospective RCT studies, a wide range of otolaryngological procedures were covered. They showed better graft uptake in myringoplasties, taking results from 60–80% in controls to 97% in those provided with these factors. Pain was very much reduced after tonsillectomies and laryngeal procedures. There was less oedema. Better results were noticed in sinus surgery with use of PRF. Supposedly, this acts as a scaffold and promotes healing. PRP offers rapid symptom control, restricting postoperative pain, persistent oedema and adhesions. Although controls were used in each study, the lack of biomarker quantification and comparison between in two groups calls for further studies to establish the benefit of these biological agents.
