Esterified Hyaluronic Acid Placed in the Middle Ear Does Not Improve Outcomes in Cholesteatoma Surgery

Letter to the Editor Regarding “Esterified Hyaluronic Acid Placed in the Middle Ear Does Not Improve Outcomes in Cholesteatoma Surgery”

“…(I) In their methods, 126 children were allocated into heterogeneous groups: 63/126 patients received HA as a sheeting material (EpiFilm) but not a filling material, of which 58/63 received only HA sheets and 5/63 patients received HA sheet + Gelfoam to support the HA sheet or tympanic membrane (TM) graft material (temporalis fascia or tragal cartilage). 1 On the other hand, as their control group, 63/126 patients did not get HA sheets, and 12/63 cases only got Gelfoam. It is also surprising that the authors did not use any filling or sheeting material to support the TM graft in 51/63 ears.…”

“…We studied with great enthusiasm the article written by Leonard et al (2022) entitled “Esterified Hyaluronic Acid Placed in the Middle Ear Does Not Improve Outcomes in Cholesteatoma Surgery.” 1 The authors carried out a non-randomized prospective cohort study on children with cholesteatoma who underwent primary surgeries to investigate the effect of hyaluronic acid (HA) sheets on cholesteatoma recurrence and middle ear pressure. 1 The authors concluded that HA sheets do not reduce the recurrence of cholesteatoma. However, the doubtful methods and results of the study are highly ambiguous.…”

“…It is also surprising that the authors did not use any filling or sheeting material to support the TM graft in 51/63 ears. 1 Since an appropriate supporting material is usually applied to prevent the displacement of the TM graft, we are curious to know how the authors became assured about preventing TM graft displacement in those 51 ears (40.4%) without any supporting material (Gelfoam or HA sheet) and what happened to their postoperative status of middle ear mucosa and the rate of retraction pocket. 1 They also excluded 3 cases in which patients were given HA sheets during canal wall down (CWD) mastoidectomy.…”

“… 1 Since an appropriate supporting material is usually applied to prevent the displacement of the TM graft, we are curious to know how the authors became assured about preventing TM graft displacement in those 51 ears (40.4%) without any supporting material (Gelfoam or HA sheet) and what happened to their postoperative status of middle ear mucosa and the rate of retraction pocket. 1 They also excluded 3 cases in which patients were given HA sheets during canal wall down (CWD) mastoidectomy. The retraction pocket is only seen in canal wall up mastoidectomy, but they did not specify how many CWD cases were in their control group.…”

“…The retraction pocket is only seen in canal wall up mastoidectomy, but they did not specify how many CWD cases were in their control group. 1 …”