A ‘chemical help’ in middle-ear surgery? A systematic review on sodium 2-mercaptoethanesulfonate

Abstract

Objective Sodium 2-mercaptoethanesulfonate (Mesna) has been proposed as a chemical aid in any surgical procedure, including cholesteatoma surgery. This review investigated the benefits and safety of Mesna during surgical management of cholesteatoma and adhesive otitis media. Method A systematic literature review was performed to identify clinical studies evaluating topical Mesna application during ear surgery (cholesteatoma or atelectasis). A qualitative analysis based on data extracted was conducted. Results From 27 articles, 5 retrospective studies were selected for a full analysis for a total of 607 patients (aged 5 to 72 years). Three studies evaluated cholesteatoma recidivism after Mesna application during cholesteatoma surgery, one study evaluated the surgical success rate of Mesna application for the treatment of atelectatic ears and adhesive otitis media, and one study evaluated potential ototoxicity of Mesna during cholesteatoma surgery. All the studies showed overall improvement in recurrence and residual cholesteatoma disease after Mesna application during surgery. Sensorineural hearing loss was not encountered after Mesna application. Conclusion Mesna application in cholesteatoma surgery could represent a valid and safe support tool during surgical treatment carried out both with microscopy and endoscopy. More studies are required to confirm these promising results.

Long-Term Results of Sodium 2-Mercaptoethane Sulfonate Usage on Cholesteatoma Surgery

“…In the study by Kalcioglu et al 3 , in which the effects of MESNA application on cholesteatoma surgery were examined, it was reported that MESNA application facilitated surgery and was found to be more effective in terms of residual disease. In the review by Moffa et al 16 , the results of 607 patients across 27 studies were examined, and it was concluded that MESNA can be safely used in facilitating surgery. All studies in the literature cover the early postoperative follow-up period; however, the results of follow-up periods between 5 and 10 years in cholesteatoma surgery are extremely important.…”

Recurrence in cholesteatoma surgery: what have we learnt and where are we going? A narrative review

“…In ENT surgery, topical MESNA has been used from ear and skull base to head and neck diseases. A review including 5 retrospective studies showed overall improvement in recurrence and residual cholesteatoma disease after MESNA application during surgery 77 , 78 . Further studies are needed to confirm these interesting findings.…”

Updates in paediatric cholesteatoma

“…MESNA has garnered attention in recent years as ‘a promising chemical dissector’. A 2021 systematic review by Moffa et al [20 ▪ ] found that there were overall decreases in recurrence rates and residual cholesteatoma disease after intraoperative use of Mesna. There were no reported cases of sensorineural hearing loss, which alleviates concern over the safety of the solution.…”