Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatoma

2007 ◽  
Vol 121 (11) ◽  
pp. 1013-1019 ◽  
Author(s):  
R Persaud ◽  
D Hajioff ◽  
A Trinidade ◽  
S Khemani ◽  
M N Bhattacharyya ◽  
...  
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Squamous Metaplasia ◽  
Retraction Pocket ◽  
Erosive Disease ◽  
Congenital Cholesteatoma ◽  
Inflammatory Conditions ◽  
Acquired Cholesteatoma ◽  
Stratified Squamous Epithelium

AbstractCholesteatoma is a non-neoplastic, keratinising lesion which has two forms: congenital and acquired. Congenital cholesteatoma develops behind a normal, intact tympanic membrane, whilst acquired cholesteatoma is associated with a defect in the tympanic membrane. The pathological substrate of cholesteatoma is keratinising stratified squamous epithelium, but the origin of this epidermal tissue in the middle ear is controversial. Here, we review the most relevant and recent evidence for the principal aetiopathogenic theories of both forms of cholesteatoma, in the light of recent otopathological findings.Congenital cholesteatoma is most plausibly explained by the persistence of fetal epidermoid formation. Conclusive ‘proof’ awaits the unambiguous demonstration of the metamorphosis of an epidermoid nidus into a lesionin vivo.Acquired cholesteatoma may develop by various mechanisms: immigration, basal hyperplasia, retraction pocket and/or trauma (iatrogenic or non-iatrogenic). However, squamous metaplasia of the normal cuboidal epithelium of the middle ear is a highly unlikely explanation. Chronic inflammation seems to play a fundamental role in multiple aetiopathogenic mechanisms of acquired cholesteatoma. Therefore early treatment of inflammatory conditions might reduce their sequelae, perhaps by preventing the development of hyperplastic papillary protrusions.Continued otopathological, cellular and molecular research would enhance our limited understanding of cholesteatoma and may lead to new therapeutic strategies for this erosive disease, which often defies surgical treatment.

Experimental Retraction Pocket Cholesteatoma

1986 ◽  
Vol 95 (6) ◽  
pp. 639-644 ◽  
Author(s):  
David E. Wolfman ◽  
Richard A. Chole
Keyword(s):  
Animal Model ◽  
Experimental Evidence ◽  
Tympanic Membrane ◽  
Eustachian Tube ◽  
Middle Ear ◽  
Mongolian Gerbils ◽  
Retraction Pocket ◽  
Tube Obstruction ◽  
Middle Ear Fluid ◽  
Acquired Cholesteatoma

An animal model for retraction pocket (primary acquired) cholesteatoma is presented. Bilateral eustachian tube obstruction by electrocauterization of the nasopharyngeal portion was performed in 16 Mongolian gerbils. Animals were killed at 2, 4, 8, and 16 weeks. At 2 weeks all animals had bilateral serous effusions and retracted tympanic membranes. At 4 weeks, four of eight ears had middle ear fluid, retractions, and cholesteatomas. After 8 weeks, five of eight ears had middle ear effusions, and four of these had cholesteatomas; one ear had total atelectasis with a cholesteatoma filling the bulla. By 16 weeks, six of eight ears had developed cholesteatomas. Some animals did not develop effusion or retraction because of failure or recanalization of eustachian tube obstruction. This study provides experimental evidence that aural cholesteatomas may arise by retraction of the tympanic membrane.

Does occurrence of keratinizing stratified squamous epithelium in the middle-ear cavity always indicate a cholesteatoma?

2004 ◽  
Vol 118 (10) ◽  
pp. 757-763 ◽  
Author(s):  
Lars-Eric Stenfors
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Squamous Epithelium ◽  
External Ear ◽  
Defence Mechanism ◽  
Ear Canal ◽  
Non Invasive ◽  
Tympanic Membrane Perforations ◽  
Acquired Cholesteatoma ◽  
Stratified Squamous Epithelium

The origin and behaviour of keratinizing stratified squamous epithelium, anessential component of cholesteatoma occurring in the middle-ear cavity, has puzzled otologistsfor decades. In this experimental study in 16 cats, central (n = 23) and peripheral (n = 9) tympanic membrane perforations were observed for up to 63 days before sacrifice. The tympanic membranes with bony rim were excised, decalcified and embedded in Epon 812. Sections werestained with toluidine blue and examined using a light microscope. The perforation had been sealed by meatal epithelium exhibiting pronounced hyperplasia and keratin formation, lying on abedof granulation tissue. Subtotal central perforations healed within 14 days, forming a bowl-shaped tympanic membrane and leaving parts of the handle of the malleus (with meatal epithelium) protruding freely into the middle-ear cavity. Stratified squamous epithelium, morphologicallyidentical with that of external ear canal epidermis, could be observed on the malleus even 63 days after operation. This meatal epithelium was non-keratinizing, non-invasive, and showed no destructive properties typical of acquired cholesteatoma. During certain circumstances, the cellcycle of hyperplastic epidermal epithelium within the middle-ear cavity can evidently be arrested and inactivated by a local defence mechanism.

Pediatric middle ear cholesteatoma: the comparative study of congenital cholesteatoma and acquired cholesteatoma

2015 ◽  
Vol 273 (5) ◽  
pp. 1155-1160 ◽  
Author(s):  
Yuka Morita ◽  
Yutaka Yamamoto ◽  
Shinsuke Oshima ◽  
Kuniyuki Takahashi ◽  
Sugata Takahashi
Keyword(s):  
Comparative Study ◽  
Middle Ear ◽  
Congenital Cholesteatoma ◽  
Middle Ear Cholesteatoma ◽  
Acquired Cholesteatoma ◽  
The Comparative Study

scholarly journals A rare case of bilateral congenital posterior mesotympanic cholesteatoma

2018 ◽  
Vol 17 (2) ◽  
pp. 307-310
Author(s):  
Ahmad Hafiz Ali ◽  
Zulkiflee Salahuddin ◽  
Mohd Khairi MD Daud ◽  
Rosdan Salim
Keyword(s):  
Soft Tissue ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Rare Case ◽  
Medical Science ◽  
Canal Wall ◽  
Common Site ◽  
Congenital Cholesteatoma ◽  
Canal Wall Down ◽  
The Common

Bilateral congenital mesotympanic cholesteatoma is a very rare disease. It can present differently from ordinary congenital cholesteatoma. We report a case of bilateral congenital cholesteatoma diagnosed at age of 22 years old. She presented with bilateral intermittent ear discharge since 10 years old that worsening two weeks prior to her presentation to our clinic and associated with bilateral reduced hearing. Clinically there was intact tympanic membrane with retraction of the mesotympanic area with present of mass medial to tympanic membrane. CT scan imaging showed there was soft tissue in the bilateral middle ear cavity with intact scutum and ossicles. Patient undergone canal wall down procedure and the diagnosis of congenital mesotympanic cholesteatoma was confirmed with present of cholesteatoma sac at the posterosuperior part, as opposed to anterosuperior quadrant, where the common site for congenital cholesteatoma.Bangladesh Journal of Medical Science Vol.17(2) 2018 p.307-310

Modified sleeve tympanotomy approach for removal of congenital cholesteatoma

2008 ◽  
Vol 122 (12) ◽  
pp. 1365-1367 ◽  
Author(s):  
H J Park ◽  
G H Park ◽  
J E Shin ◽  
S O Chang
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Conductive Hearing Loss ◽  
Tympanic Cavity ◽  
Operative Techniques ◽  
Congenital Cholesteatoma ◽  
The Right ◽  
Conductive Hearing

AbstractObjective:We present a technique which we have found useful for the management of congenital cholesteatoma extensively involving the middle ear.Case report:A five-year-old boy was presented to our department for management of a white mass on the right tympanic membrane. This congenital cholesteatoma extensively occupied the tympanic cavity. It was removed through an extended tympanotomy approach using our modified sleeve technique. The conventional tympanotomy approach was extended by gently separating the tympanic annulus from its sulcus in a circular manner. The firm attachment of the tympanic membrane at the umbo was not severed, in order to avoid lateralisation of the tympanic membrane.Conclusion:Although various operative techniques can be used, our modified sleeve tympanotomy approach provides a similarly sufficient and direct visualisation of the entire middle ear, with, theoretically, no possibility of lateralisation of the tympanic membrane and subsequent conductive hearing loss.

scholarly journals Measurement of Vibrating Tympanic Membrane in an In Vivo Mouse Model Using Doppler Optical Coherence Tomography

2019 ◽  
Vol 5 (9) ◽  
pp. 74
Author(s):  
Jeon ◽  
Kim ◽  
Jeon ◽  
Kim
Keyword(s):  
Optical Coherence Tomography ◽  
Phase Shift ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Acoustic Stimulus ◽  
Optical Coherence ◽  
Cross Sectional ◽  
Vibratory Motion ◽  
Doppler Optical Coherence Tomography

Optical coherence tomography (OCT) has a micro-resolution with a penetration depth of about 2 mm and field of view of about 10 mm. This makes OCT well suited for analyzing the anatomical and internal structural assessment of the middle ear. To study the vibratory motion of the tympanic membrane (TM) and its internal structure, we developed a phase-resolved Doppler OCT system using Kasai’s autocorrelation algorithm. Doppler optical coherence tomography is a powerful imaging tool which can offer the micro-vibratory measurement of the tympanic membrane and obtain the micrometer-resolved cross-sectional images of the sample in real-time. To observe the relative vibratory motion of individual sections (malleus, thick regions, and the thin regions of the tympanic membrane) of the tympanic membrane in respect to auditory signals, we designed an experimental study for measuring the difference in Doppler phase shift for frequencies varying from 1 to 8 kHz which were given as external stimuli to the middle ear of a small animal model. Malleus is the very first interconnecting region between the TM and cochlea. In our proposed study, we observed that the maximum change in Doppler phase shift was seen for the 4 kHz acoustic stimulus in the malleus, the thick regions, and in the thin regions of the tympanic membrane. In particular, the vibration signals were higher in the malleus in comparison to the tympanic membrane.

Auditory Tube and Middle Ear Mucosa in Nonpurulent Otitis Media

1980 ◽  
Vol 89 (3_suppl) ◽  
pp. 87-90 ◽  
Author(s):  
G. Zechner
Keyword(s):  
Middle Ear ◽  
Ossicular Chain ◽  
Fatty Degeneration ◽  
Scar Tissue ◽  
Dystrophic Calcification ◽  
Retraction Pocket ◽  
Middle Ear Mucosa ◽  
Auditory Tube ◽  
Complete Obliteration ◽  
Acquired Cholesteatoma

Most functional disturbances within the auditory tube can be shown and documented morphologically. In the case of a blocked tube we demonstrated changes on the tubal lining as well as in the adjacent salivary glands. Complete obliteration of the lumen is a very rare instance. A lack of ventilation already produces a vacuum within the tympanic cleft, followed by a typical effusion out of the altered mucosa. Anaerobic conditions favor hypertransformation and metaplastic transformation of the epithelium. The missing clearance makes the middle ear discharge a great challenge to the mucosa. Granulation tissue proliferates, an enzyme production starts, phagocytes help to eliminate the tympanic content. If the auditory tube is blocked long enough, the result is the atelectatic tympanum, filled by scar tissue, granulations with fatty degeneration or dystrophic calcification. The ossicular chain is fixed, if not destroyed or interrupted. A retraction pocket within the eardrum membrane, often a reason for secondary acquired cholesteatoma, is very dangerous.

Detection of tympanic membrane movement using film patch with integrated strain gauge, assessed by optical coherence tomography: experimental study

2011 ◽  
Vol 125 (5) ◽  
pp. 467-473 ◽  
Author(s):  
T Just ◽  
T Zehlicke ◽  
O Specht ◽  
W Sass ◽  
C Punke ◽  
...  
Keyword(s):  
Experimental Study ◽  
Optical Coherence Tomography ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Strain Gauge ◽  
Ex Vivo ◽  
Optical Coherence ◽  
Middle Ear Pressure ◽  
Pressure Changes

AbstractObjective:We report an ex vivo and in vivo experimental study of a device designed to measure tympanic membrane movement under normal and pathological conditions, assessed using optical coherence tomography.Materials and methods:We designed two types of flexible, round film patch with integrated strain gauge, to be attached to the tympanic membrane in order to measure tympanic membrane movement. Tympanic membrane attachment was assessed using optical coherence tomography. The devices were tested experimentally using an ex vivo model with varying middle-ear pressure.Results:Optical coherence tomography reliably assessed attachment of the film patch to the tympanic membrane, before and after middle-ear pressure changes. Strain gauge voltage changes were directly proportional to middle-ear pressure recordings, for low pressure changes. Tympanic membrane perforations smaller than 2 mm could be sealed off with the film patch.Conclusion:Attachment of the film patch with integrated strain gauge to the tympanic membrane was not ideal. Nevertheless, the strain gauge was able to precisely detect small pressure changes within the middle ear, in this experimental model.

scholarly journals Pathogenesis of Retraction Pocket of the Tympanic Membrane—A Narrative Review

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 425
Author(s):  
Milan Urík ◽  
Miroslav Tedla ◽  
Pavel Hurník
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Immunohistochemical Study ◽  
Current Knowledge ◽  
Immunohistochemical Analysis ◽  
Narrative Review ◽  
Retraction Pocket ◽  
Middle Ear Pressure ◽  
A Current

Several theories describe the development of the retraction pocket of the tympanic membrane (RP). Many authors suggest that the negative middle ear pressure is the main reason responsible for developing this condition. A narrative review has been undertaken, and conclusions are drawn reflecting a current knowledge with our new observations in the histological and immunohistochemical study. Recent studies show the important role of inflammation in the development and progression of RP. A review of the available literature shows that the inflammation plays a key role in pathogenesis of the RP and its progression to the cholesteatoma. We support this statement with our new results from histological and immunohistochemical analysis of the RPs.

Acquired cholesteatoma pathogenesis: stepwise explanations

2010 ◽  
Vol 124 (6) ◽  
pp. 587-593 ◽  
Author(s):  
L Louw
Keyword(s):  
Tympanic Membrane ◽  
Clinical Intervention ◽  
Disease Research ◽  
Inflammatory Conditions ◽  
Retraction Pockets ◽  
Acquired Cholesteatoma ◽  
Cone Formation ◽  
The Subject ◽  
Insight Into

AbstractBackground:Since Virchow's first, 1855 publication on cholesteatoma, this disease has been the subject of extensive debate. The pathogenesis of acquired cholesteatoma is repeatedly explained on the premises of the migration, hyperplasia and metaplasia theories, but proof for the latter theory remains limited. In retrospect, there is progress toward better understanding of all the pathological mechanisms involved, as expounded in this review.Discussion:The triggers for cholesteatoma onset are diverse, and may involve tympanic membrane trauma (i.e. perforation, displacement, retraction or invagination), tympanic membrane disease, and/or tympanic cavity mucosa disease. Research has revealed that cell migration is replaced under inflammatory conditions by hyperplasia, which triggers the onset of cholesteatoma. Lately, the hyperplasia theory gained prominence and circumscription of the papillary cone formation concept provided insight into cholesteatoma progression (growth and expansion). Diseased mucosa can contribute to the development of retraction pockets and cholesteatoma. The type of cholesteatoma trigger and the role of chronic inflammation during disease progression and recurrence are important in guiding clinical intervention.

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