We read the comments by Kuczkowski et al. regarding our manuscript published in the journal . We would like to thank to the authors for their comments which in general support what we have observed in the use of MESNA. As the authors mentioned MESNA (sodium 2-mercapto-ethane sulphonate) is a synthetic sulfur compound that produces mucolysis by disrupting disulfide bonds. This way it facilitates the dissection of squamous epithelium in cases of retraction and adhesion. Moreover the likelihood of leaving some remnants of squamous epithelium may decrease, which is critical in terms of prevention of cholesteatoma recurrence.

As the authors have already quoted one of the articles published before , there is a clinical observation showing the practical use of MESNA in the middle ear surgeries. However, confirmation of these clinical observations is important, because MESNA also has hydraulic effect when injected, which may also help elevation of the retraction. This creates the critical question as to whether MESNA helps dissection of the epithelium through its chemical or hydraulic effect. Confirmation of this needs histopathological studies as well as case control studies comparing MESNA versus saline.

In conclusion, from a practical point of view and based on our observation MESNA seems to help dissection of the squamous epithelium. It is encouraging to know that Kuczkowski et al. share the same idea with us and have a similar observation. We look forward to seeing their study results in the near future.