Purpose <p>We evaluated the effectiveness of cartilage tympanoplasty type 1 combined with platelet-rich plasma (PRP) compared to cartilage tympanoplasty type 1 alone in dry tympanic membrane (TM) perforation due to chronic otitis media, demonstrating the safety and efficacy of PRP in tissue repair and regeneration.</p> Methods <p>Data were retrieved from the literature up to April 2025. Outcomes of interest were success rate (complete closure of the TM postoperatively), postoperative air-conduction (AC) threshold, and changes in air–bone gap (ABG) and AC threshold (preoperatively to postoperatively). Pooled effects were calculated using standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs).</p> Results <p>PRP-augmented cartilage tympanoplasty type 1 significantly improved ABG and AC compared to cartilage tympanoplasty type 1 alone (SMD 0.4517; 95% CI [0.1010; 0.8025], I² = 0.0%) and AC (SMD 0.6193, 95% CI [0.2088; 1.0297]; I² = 0.0%), and postoperative AC thresholds were significantly lower (SMD − 0.6194, 95% CI [− 0.9810; −0.2577]; I² = 22.7%). The success rate of cartilage tympanoplasty type 1 with PRP significantly increased compared to cartilage tympanoplasty type 1 alone (OR 6.8721; 95% CI [3.2868; 14.3683], I² = 0.0%) and combination therapy resulted in superior outcomes in all follow-up periods. PRP significantly reduced postoperative infection rates, but there was no significant difference in infection incidence between the two groups (OR 0.1843, 95% CI [0.0208; 1.6359]; I² = 0.0%).</p> Conclusion <p>The autologous PRP application during cartilage tympanoplasty type 1 leads to higher success rates and greater hearing improvement, and also increases the success rate during all follow-up periods.</p>