See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/337731185

Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing

Loss

Article in Acta Oto-Laryngologica · December 2019

CITATIONS READS
7 16,231

3 authors, including:

Mamatarani Rout
Sri Siddhartha University
10 PUBLICATIONS 9 CITATIONS

SEE PROFILE

All content following this page was uploaded by Mamatarani Rout on 04 December 2019.

The user has requested enhancement of the downloaded file.

 Acta Scientific Otolaryngology (ASOL)
Volume 1 Issue 4 December 2019
Research Article

Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss

BPS Tyagi1,2* and Mamatarani Rout3

1
Head of Department of ENT, Colombia Asia Hospital Ghaziabad
2
Head of Department of ENT, Harsh ENT Hospital, Ghaziabad
3
Junior Consultant Department of ENT, Harsh ENT Hospital, Ghaziabad
*Corresponding Author: BPS Tyagi, Head of Department of ENT, Colombia Asia Hospital and Harsh ENT Hospital, Ghaziabad.
Received: September 19, 2019

Abstract
Sensorineural hearing loss is the collective term for hearing damage to the cochlea and auditory nerve, and is by far the most
common type of hearing loss in adults, accounting for over 90% of all cases. Sensorineural hearing loss is a heterogeneous disorder,
which can arise due to damage to pathway for sound impulses from the hair cells of inner ear to auditory nerve and less commonly
brain. Sensorineural hearing loss is a challenge to physicians, as it progresses with age and causes significant reductions in quality of
life and there are no treatments to reverse its effects, other than sound amplification with the use of hearing aids or direct auditory
nerve stimulation via cochlear implantation.
Platelet-rich Plasma (PRP) Therapy is a cutting edge procedure that is revolutionizing the hearing loss and deafness. Intratympanic
instillation of Platelet-rich Plasma (PRP) does wonder to the hair cells of inner ear,thus improving the hearing.
Keywords: Sensorineural Hearing Loss; Platelet Rich Plasma; Intratympanic

Introduction The efficacy of certain growth factors in healing various injuries

Platelet rich plasma (PRP) is a form of blood plasma that has and the concentrations of these growth factors found within PRP
been enriched with platelets and growth factors. Platelets are tiny are the theoretical basis for the use of PRP in tissue repair.
cell fragments that stop bleeding and bruising and contain growth
The platelets collected in PRP are activated by the addition of
factors and natural substances that encourage cellular growth and
thrombin and calcium chloride, which induces the release of the
stimulate healing.
mentioned factors from alpha granules. The growth factors and
other cytokines present in PRP include:
Platelet-rich plasma (PRP), also known as autologous condi-
• Platelet-derived growth factor.
tioned plasma, is a concentrate of platelet-rich plasma protein
• Transforming growth factor beta.
derived from whole blood, centrifuged to remove red blood cells.
• Fibroblast growth factor.
Composition
• Insulin-like growth factor 1.
There are four general categories of preparation of PRP based • Insulin-like growth factor 2.
on its leukocyte and fibrin content: leukocyte-rich PRP (L-PRP), • Vascular endothelial growth factor.
leukocyte reduced PRP (P-PRP; leukocyte reduced or pure PRP), • Epidermal growth factor.
leukocyte platelet-rich fibrin and pure platelet-rich fibrin. • Interleukin 8.
• Keratinocyte growth factor.
• Connective tissue growth factor.

Citation: BBPS Tyagi and Mamatarani Rout. “Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss". Acta Scientific
Otolaryngology 1.4 (2019).
Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss

Preparation Buffy coat method

PRP is obtained from a sample of patients’ blood draw at the 1. Whole blood should be stored at 20°C to 24°C before cen-
time of treatment. A 30 cc venous blood draw will yield 3 - 5 cc of trifugation.
PRP depending on the baseline platelet count of an individual, the 2. Centrifuge whole blood at a ‘high’ speed.
device used, and the technique employed. The blood draw occurs
3. Three layers are formed because of its density: The bot-
with the addition of an anticoagulant, such as citrate dextrose A to
tom layer consisting of RBCs, the middle layer consisting
prevent platelet activation prior to its use.
of platelets and WBCs and the top PPP layer.
4. Remove supernatant plasma from the top of the container.
PRP is prepared by taking blood from the person, and then put-
ting it through two stages of centrifugation designed to separate 5. Transfer the buffy-coat layer to another sterile tube.

PRP from platelet-poor plasma and red blood cells. This is usually 6. Centrifuge at low speed to separate WBCs or use leuco-
done by the clinic offering the treatment, using commercially avail- cyte filtration filter.
able kits and equipment. The resulting substance varies from per- Factors influencing PRP yield
son to person and from facility to facility. Various factors influence the yield of PRP such as draw of blood;
speed, time and temperature of centrifugation and use of antico-
PRP is prepared by a process known as differential centrifuga- agulants.
tion. In differential centrifugation, acceleration force is adjusted to
Draw of blood
sediment certain cellular constituents based on different specific
The clotting process is influenced from the time of the draw. To
gravity. There are many ways of preparing PRP. It can be prepared
avoid unintentional activation of platelets, most protocols use large
by the PRP method or by the buffy-coat method. In the PRP meth-
bore needles (> 22) to draw the blood.
od, an initial centrifugation to separate red blood cells (RBC) is fol-
lowed by a second centrifugation to concentrate platelets, which Centrifugation
are mainly white blood cells (WBCs) and platelets, from the under- Separation of cellular constituents within blood can be achieved
lying RBC layer. by a process known as differential centrifugation.
PRP method Temperature
1. Obtain whole blood by venipuncture in acid citrate dex- Temperature during processing is crucial to prevent platelet ac-
trose (ACD) tubes. tivation. AABB manual recommends 21°C–24°C for centrifugation
2. Do not chill the blood at any time, before or during plate- of blood for obtaining PRP.
let separation. Activation of PRP
3. Centrifuge the blood using a ‘soft’ spin. PRP activation prior to injection is another parameter that re-
4. Transfer the supernatant plasma containing platelets quires further discussion. PRP can be activated exogenously by
into another sterile tube (without anticoagulant). thrombin, calcium chloride or mechanical trauma.
5. Centrifuge tube at a higher speed (a hard spin) to obtain Mechanism of action: PRP has the potential to deliver a high
a platelet concentrate. concentration of growth factors to target tissues by virtue of the
6. The lower 1/3rd is PRP and upper 2/3rd is platelet-poor contents within the alpha and dense granules.
plasma (PPP). At the bottom of the tube, platelet pellets
• Alpha granules contain seven fundamental growth fac-
are formed.
tors: platelet-derived growth factors (PDG Faa, PDG Fbb
7. Remove PPP and suspend the platelet pellets in a mini- and PDG Fab); transforming growth factor beta (isoforms
mum quantity of plasma (2-4 mL) by gently shaking the TGFβ1 and 2); epithelial growth factor (EGF); and vascu-
tube. lar endothelial growth factor (VEGF). These modulate cell
proliferation, cellular migration, differentiation, angio-

Citation: BBPS Tyagi and Mamatarani Rout. “Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss". Acta Scientific
Otolaryngology 1.4 (2019).
Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss

genesis and chemotaxis. The dense granules contain bioactive came with reduced hearing and fullness of ear were evaluated with
agents including serotonin, histamine, dopamine, calcium and adequate investigations such as PTA, BERA.
adenosine; these can increase membrane permeability and
modulate inflammatory processes. The samples were assessed based on gender, age, duration of
hearing loss, laterality of hearing loss (unilateral, bilateral), type of
• Degranulation of these organelles results in the release of
hearing loss (conductive, sensorineural) and presence of pathologi-
pre-packaged growth factors, many of which have short half-
cal tissues (perforation, granulation, cholesteatoma, destruction
lives; therefore, greater effectiveness may result if they are
of ossicles). Based on audiogram 200 patients were selected with
activated at or just before application. PRP has 3 - 5 times the
pure sensorineural and mixed hearing loss. Study conducted in 200
concentration of platelets normally found in wounds and the
patients over a period of 1 year. We instilled injection PRP 0.5ml
resulting growth factor release following activation can fur-
intratympanic in patients (n = 200). Injections were repeated every
ther stimulate cell proliferation and differentiation towards
3weeks with audiogram and compared with previous audiogram.
tissue regeneration.
Discussion Out of 200 patients with injection PRP intratympanic, 172 pa-
Patients with sensorineural hearing loss comes with c/o tients were having improvement in hearing after 5 times of repeat-
Plugged feeling or fullness in the ear, tinnitus, vertigo, hearing loss. ed injections and 28 patients didn’t show any improvement in hear-
There is limited options for treatment of SNHL. Pharmacological ing. Out of 28 patients, 19 patients were above 70years and with
treatment such as antioxidant vitamins, coenzyme Q10 options are diabetes, and 9 were above 70 years old.
very limited and clinically unproven. Such pharmaceutical treat-
Out of 200 patients: total no of patients =200.
ments as are employed are palliative rather than curative, and ad-
dressed to the underlying cause if one can be identified, in order Age group in years No of patients
to avert progressive damage. Profound or total hearing loss may 0-5 5
be amenable to management by cochlear implants, which stimu-
6-20 31
late cochlear nerve endings directly. A cochlear implant is surgical
20-40 82
implantation of a battery powered electronic medical device in the
40-60 45
inner ear. Cochlear implant can be done under 3years of age which
>60 37
in helpful. In our center we use PRP (platelet rich plasma) injection
as treatment for SNHL along with few medications. Table 1
Dose and time interval
This table shows the maximum number of incidence of SNHL is
Injection PRP 0.5 ml is injected intratympanic in round window in the age group of 20 to 40 years of age.
niche. S Can be monitored with audiogram results each time pa-
Conclusions
tient reviews. After injection patient should be on 5days of antibi-
Previously there was no specific treatment management for sen-
otic, antihistamines and antacids and analgesics sos.
sorineural hearing loss except antioxidants and steroids. Introduc-
Side effects tion of platelet rich plasma in otorhinolaryngology and especially in
No side effects has been reported. sensorineural hearing loss is doing revolutionary wonders in treat-
Contraindications ment as we can see in our case study report.
Cancer, Chronic liver disease, Hemodynamic instability, Hypofi- Conflict of Interest
brinogenemia, Platelet dysfunction syndromes, Systemic disorder, None.
sepsis, Low platelet count.
Source of funds
Method Nil.
This case series study was carried out in ENT department of
Harsh ENT hospital, Ghaziabad during June 2018. All patients who

Citation: BBPS Tyagi and Mamatarani Rout. “Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss". Acta Scientific
Otolaryngology 1.4 (2019).
Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss

Bibliography 11. Canbin Zheng., et al. “Improved Peripheral Nerve Regeneration

Using Acellular Nerve Allografts Loaded with Platelet-Rich
1. Ikumi A., et al. “Effect of local administration of platelet-rich
Plasma”. Tissue Engineering Part A.
plasma (PRP) on peripheral nerve regeneration: An experi-
mental study in the rabbit model”. Microsurgery 12. Hakan Teymur., et al. “Effect of platelet-rich plasma on recon-
struction with nerve autografts”. The Kaohsiung Journal of
2. Küçük L., et al. “Effects of platelet-rich plasma on nerve regen-
Medical Sciences.
eration in a rat model”.

3. Fijnheer R., et al. “Platelet activation during preparation of Volume 1 Issue 4 December 2019
platelet concentrates: a comparison of the platelet-rich plas- © All rights are reserved by BPS Tyagi and Mamatarani
ma and the buffy coat methods”. Transfusion 30 (1990): 634-
Rout.
638.

4. Dohan Ehrenfest DM., et al. “Three-dimensional architecture

and cell composition of a Choukroun’s platelet-rich fibrin clot
and membrane”. Journal of Periodontology 81 (2010): 546-
555.

5. Addressing Reproducibility in Stem Cell and PRP Therapies.

6. Akira Ikumi., et al. “Intraoperative Local Administration of

Platelet-Rich Plasma (PRP) during Neurolysis Surgery for the
Treatment of Digital Nerve Crush Injury”. Case Reports in Or-
thopedics

7. José Sidney RoqueI., et al. “Inside-out and standard vein grafts

associated with platelet-rich plasma (PRP) in sciatic nerve re-
pair”.

8. Ramak Roohipour., et al. “The Effect of Panretinal Photocoagu-

lation (PRP) versus Intravitreal Bevacizumab (IVB) Plus PRP
on Peripapillary Retinal Nerve Fiber Layer (RNFL)Thickness
Analyzed by Optical Coherence Tomography in Patients with
Proliferative Diabetic Retinopathy”. Journal of Ophthalmic &
Vision Research.

9. H B Lu., et al. “Experimental study of using chitosan nerve

conduit combined with PRP to repair facial nerve defect”.

10. Luiz Augusto Lucas Martins De Rizzo., et al. “Nerve Regenera-

tion: Is There an Alternative to Nervous Graft?”. Journal of Re-
constructive Microsurgery

Citation: BBPS Tyagi and Mamatarani Rout. “Platelet Rich Plasma (PRP): A Revolutionary Treatment of Sensorineural Hearing Loss". Acta Scientific
Otolaryngology 1.4 (2019).

View publication stats