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
The authors of this systematic review and meta-analysis explored the efficacy and safety of intranasal platelet-rich plasma (PRP) for persistent olfactory disorders (OD), including post-Covid-19, post-viral and post-traumatic causes. Seven studies involving 473 patients were included, with 2 randomised controlled trials and 5 non-randomised or single-arm studies. Across controlled studies, PRP produced a moderate treatment effect (standardised mean difference 0.61), while the pooled improvement in Sniffin’ Sticks Threshold-Discrimination-Identification (TDI) scores was 7.73 points, exceeding the minimal clinically important difference of 5.5 points. Approximately 75% of patients achieved clinically meaningful improvement. Benefits were observed across different aetiologies, including chronic post-Covid-19 and post-traumatic olfactory loss. PRP was generally well tolerated, with adverse events primarily limited to mild, transient symptoms such as epistaxis, nasal congestion and postnasal drip. No serious complications were reported. The proposed mechanism involves delivery of growth factors and neurotrophic mediators that may promote olfactory epithelial regeneration, reduce inflammation and support neuronal recovery. Despite promising results, the authors emphasise that current evidence is preliminary due to small sample sizes, heterogeneous treatment protocols, short follow-up periods and the limited number of randomised trials. Larger, standardised studies are needed to define optimal treatment protocols and determine the role of PRP alongside established therapies such as olfactory training.
