mesna and Otitis-Media

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.. 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.. 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.. 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.

Topics: Cholesteatoma, Middle Ear; Ear, Middle; Humans; Mesna; Otitis Media; Protective Agents

To evaluate the effectiveness of the chemically assisted dissection with sodium 2-mercaptoethanesulfonate (MESNA), in the reduction of residual and recurrent cholesteatoma after mastoidectomy in children with chronic cholesteatomatous otitis media (CCOM).. Retrospective case-control study.. Tertiary referral center.. One hundred forty mastoidectomies performed in patients under 18 years of age for the treatment of CCOM.. Chemically assisted dissection (CAD) with MESNA compared with surgical dissection without MESNA.. Recidivism of cholesteatoma (recurrence and residual disease), variations in the average of bone conduction threshold after treatment, and complications.. Recidivism of cholesteatoma was significantly lower when CAD with MESNA was used (p < 0.0001). No difference was found in the mean variation of the average of bone conduction thresholds between the groups, confirming its safety profile regarding auditory function. Meatoplasty stenosis after surgery was more prevalent within CAD with MESNA group (p: 0.049).. Recurrent and residual cholesteatoma remains a problem, especially in children and despite surgical techniques such as canal wall down mastoidectomy and endoscopic ear surgery. CAD with MESNA can be safe and effective to reduce recurrence rates. Multicenter and prospective studies with larger number of patients are needed to validate these findings. The higher rate of meatoplasty stenosis after CAD with MESNA merits additional clinical research to confirm these findings, as well as in vitro studies evaluating the effect of the drug on the activity of fibroblasts and other growth factors that may be involved.

Topics: Adolescent; Case-Control Studies; Child; Child, Preschool; Cholesteatoma, Middle Ear; Dissection; Female; Humans; Male; Mastoidectomy; Mesna; Otitis Media; Recurrence; Retrospective Studies; Treatment Outcome

Pediatric cholesteatoma is a clinically challenging disease entity. Its biological behavior in the pediatric population differs from its behavior in adult population in terms of aggressiveness and recurrence. Several studies have shown the presence of biofilms associated with cholesteatoma that hinder the management and eradication of the infection. This led is to study the use of non-antimicrobial treatments impacting on the structure or composition of biofilms.. To evaluate the changes that occur in the biofilm of cholesteatoma in pediatric patients after the application of sodium 2-mercaptoethanesulfonate (MESNA).. A pilot study of 10 pediatric patients, with a median age of 10 years and a diagnosis of cholesteatomatous chronic otitis media, who underwent surgery for primary or revision mastoidectomy in the Otorhinolaryngology Service of the Hospital Infantil de México Federico Gómez between January 2016 and May 2017. During the surgery, basal samples of cholesteatoma and tissue were taken after topical application of 4% MESNA for 10 min. The samples were then processed for confocal laser microscopy.. In all samples structures compatible with bacterial biofilms were identified. The most relevant finding was the changes in the structure of the biofilm after the application of MESNA, such as disintegration and separation of the underlying tissue.. This is the first study that showing changes associated with cholesteatoma in the structure of the bacterial biofilm after the application of MESNA. The observed disintegration of cholesteatoma biofilm ultrastructure could aid in the management of the chronic infection associated with cholesteatoma.

Topics: Adult; Biofilms; Child; Child, Preschool; Cholesteatoma, Middle Ear; Chronic Disease; Female; Humans; Male; Mastoid; Mesna; Mexico; Otitis Media; Pilot Projects; Protective Agents

MESNA is a synthetic sulfur compound that produces mucolysis by disrupting disulfide bonds. This study aimed to address indications and technique of MESNA application in otologic surgery, especially in retraction pockets and adhesive otitis media.. MESNA application was performed in 42 ears of 39 patients. The diagnoses were retraction pockets fixed to incudostapedial joint, stapes or promontorium, and adhesive otitis media in 24 and 17 ears, respectively. Calculations were performed according to 24 ears of 23 patients with follow-up data.. One or more of the following surgical interventions were performed: MESNA application alone and ventilation tube insertion, reinforcement or mastoidectomy in addition to MESNA application. Sensorineural hearing loss was not encountered after MESNA application. The operation was successful in 79.2%. Overall revision surgery was needed in 20.8% of the ears. In 71.4% of the ears treated with MESNA alone, revision surgery was needed.. In the light of our experience, we advocate the use of MESNA in atelectatic ears, because it makes the operation easy and safe by allowing elevation of the tympanic membrane by its mechanical and chemical actions.

Topics: Adolescent; Adult; Aged; Child; Ear Diseases; Humans; Mesna; Middle Aged; Otitis Media; Protective Agents; Treatment Outcome; Tympanic Membrane