Effectiveness and Safety of Platelet-Rich Plasma Injection for Vocal Fold Scar and Sulcus Vocalis: A Systematic Review and Meta-Analysis.

Abstract

Background: Platelet-rich plasma (PRP) has emerged as a regenerative therapy aimed at improving tissue healing and vocal fold function; however, clinical evidence remains limited. This systematic review and meta-analysis aim to evaluate the effectiveness and safety of PRP injection for the treatment of vocal fold scar and sulcus vocalis.

Methods: PubMed, Scopus, and Web of Science were searched from inception until October 25, 2025, to identify studies evaluating PRP injection for vocal fold scar or sulcus vocalis. Outcomes included patient-reported voice disability, perceptual voice assessment, acoustic and functional measures, subjective improvement outcomes, and complications. Random-effects models were used to pool effect estimates. Risk of bias was assessed using study design-specific tools.

Results: Nine studies comprising 353 patients were included. PRP injection was associated with a significant improvement in voice handicap index-10 scores (mean difference -6.74, 95% confidence interval -9.88 to -3.59), although substantial heterogeneity was observed (I² = 77.44%). Significant improvements were also observed in most GRBAS perceptual voice domains and vocal fatigue index scores. Cepstral spectral index of dysphonia scores improved significantly, whereas no significant changes were observed in jitter, fundamental frequency, or maximum phonation time. A substantial proportion of patients reported improvement in voice quality, ease of phonation, and stroboscopic findings following PRP injection. Reported complications were predominantly mild and transient. Overall evidence quality was limited by small sample sizes, heterogeneity in treatment protocols, and predominance of non-randomized studies.

Conclusions: PRP injection for vocal fold scar and sulcus vocalis may be associated with improvements in patient-reported voice disability and perceptual voice quality, with a generally favorable safety profile. However, evidence for objective acoustic and functional outcomes remains inconsistent, and the overall quality of evidence is limited, precluding definitive conclusions. Further well-designed randomized trials are needed to establish an accurate efficacy and safety profile.