Practical Use of MESNA in Atelectatic Ears and Adhesive Otitis Media

Abstract

Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Electrophysiological and Histopathological Evaluation of Effects of Sodium-2 Mercaptoethanesulfonate Used for Middle Ear Surgery on Facial Nerve Functions

“…Previous studies have reported that the use of MESNA in atelectatic and adhesive middle ear and cholesteatoma surgery is not associated with ototoxic effects and had neuroprotective effects; however, to the best of our knowledge, its direct effect on the facial nerve has not been demonstrated [7][8][9][10]12] . The possibility of dehiscence development in the fallopian canal of the facial nerve is very high in the presence of pathologies progressing with dissolving bone structures, such as cholesteatoma; the use of MESNA for separating the cholesteatoma matrix in such surgeries inevitably results in contact with the facial nerve, directly or by passing through bony dehiscence.…”

“…It is used as a cytoprotective agent to prevent hemorrhagic cystitis and as a mucolytic agent to improve pulmonary functions. In addition, the sulfhydryl group has the potential to clean the reactive oxygen metabolites and is used as a systemic protective agent against chemotherapy toxicity [9,11] .…”

“…Chemical separation of these bonds allows dissection to be performed more easily and effectively during surgery [8] . Sodium-2-mercapElectrophysiological and Histopathological Evaluation of Effects of Sodium-2 Mercaptoethanesulfonate Used for Middle Ear Surgery on Facial Nerve Functions toethanesulphonate (MESNA), a sodium salt of 2-thiosulphonate anion, is now used for this purpose during otologic surgery; it provides more effective dissection because it cleaves the disulfide bonds [9] . In addition, because MESNA is a synthetic sulfur compound, it enables separation of mucus polypeptide chains by mucolysis of the disulfate bonds [9] .…”

The Effects of MESNA on the Facial Nerve, an Experimental Animal Study

“…These complications usually occur while performing mechanical dissection of the cholesteatoma matrix from the underlying structures. Yilmaz et al [10] reported that MESNA was successful in atelectatic ears and adhesive otitis media because it made the operation easier and safer by allowing elevation of the tympanic membrane through its mechanical and chemical actions. Kalcioglu et al [14] investigated the use of 20% MESNA in chronic otitis with cholesteatoma and reported that it could be helpful for eliminating the disease and increasing surgical success.…”

“…As used in other surgical areas, MESNA can be used during middle ear surgery, such as in the case of cholesteatoma or atelectatic ears, when dissecting the tissue layers [10] . The matrix of cholesteatoma is mainly composed of keratin, a protein rich in disulfide bonds.…”