Is MESNA an effective drug preventing recurrence of cholesteatoma after surgical treatment?

摘要

We have read with pleasure the article by Kalcioglu MT. et al. [1] which presents very important clinical observations. We would like to make some comments on this problem, basing on our experience and the literature review. MESNA (sodium 2-mercapto-ethane sulphonate) is a synthetic sulfur compound that produces mucolysis by disrupting disulfide bonds of the mucus polypeptide chain. MESNA can be used during ear "surgeries (cholesteatoma or atelectasis), to make the dissection of keratinocyte layers [2,3]. But a question remains over the possible mechanism of action of MESNA in chronic otitis media. Therefore, we would like to share our opinion in this subject. Cholesteatoma is composed of matrix (stratified squamous keratinizing epithelium with keratinocyte), layers of exfoliated epithelium with keratin, perimatrix (connective tissue) and, in most of the cases, bacterial biofilm consisting of colonies of Pseudomonas aeruginosa, Proteus mirabilis or Staph-ylococcus aureus [3]. In chronic otitis with atelectasis, one of the issues is to remove the keratinocytes released from the retraction pocket. MESNA contributes to breaking of the disulfide bonds in exfoliated keratinocytes, and therefore facilitating their removal. In open-type cholesteatoma (common in children and in cholesteatoma recurrence) with presence of bacterial biofilm MESNA enables even easier and more efficient control of the exfoliated epithelium, especially in the environment with low pH [3].