Mesna in Otologic Surgery: Efficacy and Safety-A Scoping Review

Mesna (Sodium 2-mercaptoethanesulfonate) is widely used as a mucolytic agent and uroprotective agent. Recently, its disulfide bond-breaking property has been applied in otologic surgery to facilitate safer dissection of cholesteatoma and other adhesions. This review evaluates the effectiveness and toxicity of Mesna in its various uses of otologic surgeries.

A comprehensive literature search was conducted with the aid of a senior medical librarian across eight databases conducted from inception until December 28, 2024: Google Scholar, Medline (Ovid), Embase (Ovid), CINAHL (Ebsco), Cochrane (Wiley), Global Health (Ovid), Web of Science (Clarivate Analytics), Africa Wide Information (Ebsco), and Global Index Medicus (WHO). No language or publication status restrictions were applied.

This review was reported following the PRISMA-ScR guidelines. Studies were eligible if they investigated the use of Mesna in otology (human or animal) and reported on either efficacy or toxicity. Two reviewers independently screened all titles/abstracts and full texts, with a third resolving discrepancies. Data were charted on application methods, concentrations, outcomes, and adverse effects and synthesized qualitatively.

Eighteen studies (nine human, nine animal) met inclusion criteria. Mesna was effectively used in cholesteatoma surgery, ossicular chain fixation, tympanic tube replacement, and adhesive otitis media. Four percent to one hundred percent Mesna was used, without significant signs of toxicity in animal models and clinical research.

Mesna could be used effectively and safely in otologic surgery. Further research is needed to optimize concentration, method of administration, time of contact, and to quantify its effect.

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