A chemical ‘magic bullet’ capable of eradicating cholesteatoma has long been sought. Sodium 2-mercaptoethanesulfonate, also known as mesna, a mucolytic agent capable of disrupting disulphide bonds, has recently been proposed as a drug that may facilitate surgical dissection; this is the concept of ‘chemically assisted dissection’. In this month's issue, Moffa et al. investigate the beneficial effects and safety of the topical application of mesna compared with placebo during the surgical management of cholesteatoma and adhesive otitis media.Reference Moffa, Fiore, Sabatino, Cassano, Tarabichi and Kapadia1 In their systematic review, data derived from five clinical studies demonstrate that topical mesna administration could represent a potential therapeutic option during surgical dissection performed both through the microscope and with otoendoscopy. Further studies, however, are required to confirm these results, and to identify the optimal administration method and treatment schedule.
Eustachian tube dysfunction following radiotherapy for nasopharyngeal carcinoma is a challenging condition to manage. Invariably this leads to otitis media with effusion, and ventilation tube insertion frequently will result in a persistent perforation and/or chronic otorrhoea. Based on the promising results of previous studies investigating Eustachian tube balloon dilatation in Eustachian tube dysfunction,Reference McMurran, Hogg, Gordon, Spielmann and Jones2 Wong et al., in this month's issue of The Journal, study its safety and efficacy in the post-radiotherapy setting.Reference Wong and Narayanan3 Despite the small sample size, the ‘success rate’ (defined by improvements in tympanometry and Eustachian Tube Dysfunction Questionnaire 7 scores) of Eustachian tube balloon dilatation in the post-irradiation group was inferior compared to the non-irradiated group. The authors hypothesise that in post-radiotherapy patients the damaged segment of the Eustachian tube may be fibrosed and stenosed, hence the ineffectiveness of the balloon treatment. Patients were only recruited a minimum of six months after radiotherapy, and it is feasible that earlier intervention, before fibrosis and mature scarring have developed, may be more effective. A more recent study has shown more promising results, at least in the short term.Reference Sun, Cao, Qui, Hu and Zhang4
The coronavirus disease 2019 (Covid-19) pandemic has had a significant impact on undergraduate teaching and education, which has in many cases been replaced with virtual learning. The medical student's experience of ENT teaching during the pandemic is explored in an article by Walker and Stapleton in this month's issue.Reference Walker and Stapleton5 While virtual learning received good feedback, students still preferred face-to-face teaching sessions. In a complementary article, patients’ perspectives of undergraduate clinical placements during the Covid-19 pandemic are explored.Reference Patel, Gera, Lozidou, Hannan and Saeed6 In that study, the majority of patients felt comfortable with students’ direct participation in their care; thus, face-to-face placements remain viable from a patient's perspective. In addition, patients reported remaining comfortable with a variety of approaches that enabled the ongoing provision of undergraduate placements in ENT. These approaches include direct observation of their appointments, remote observation of consultations and the sharing of anonymised clinical findings with students.
