Medical Research: Emerging Concepts and Applications Vol. 6

Tympanic membrane perforation remains one of the most common structural consequences of chronic middle-ear disease, and surgical closure continues to fail in a clinically meaningful minority of cases despite refinements in graft material and surgical access. Platelet-rich fibrin, an autologous second-generation platelet concentrate produced without anticoagulant or bovine thrombin, has been promoted over the past two decades as a biologically active adjunct capable of improving graft uptake, accelerating epithelial closure and reducing postoperative infection. This review critically evaluates the coherence between the biological rationale for platelet-rich fibrin and the clinical evidence assembled in otology, and examines why pooled estimates of benefit and the findings of the most recent controlled trials have diverged. Literature was identified through structured searching of scholarly databases and indexes covering the period from the introduction of the technique to mid-2026, supplemented by backward and forward citation tracking, and appraised against design-specific criteria rather than a formal scoring instrument. Three findings emerge. The laboratory rationale is internally consistent and reproducible, resting on sustained growth-factor release from an autologous fibrin scaffold, but it has been transferred to the middle ear largely by analogy with oral and periodontal applications rather than through tympanic-specific mechanistic work. Early clinical studies reported large anatomical advantages, whereas trials published after 2023, several with larger samples, tighter blinding and active rather than inert comparators, have reported no significant difference in graft uptake. Anatomical and audiological outcomes are consistently dissociated, with no reproducible hearing advantage attributable to the concentrate itself. Preparation protocols, application formats and comparator choices differ so widely between studies that the intervention evaluated is not a single entity, and pooled odds ratios derived from such material overstate the precision of what is known. The evidence supports platelet-rich fibrin as a safe, inexpensive and logistically convenient autologous material with a plausible adjunctive role in selected perforations, but it does not yet support claims of superiority over established graft techniques. Protocol standardisation, transparent reporting and adequately powered trials with active comparators are prerequisites for any stronger conclusion.