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

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.