The Pathophysiology of Cholesteatoma
Section snippets
Congenital cholesteatoma
The first published description of a congenital cholesteatoma appeared in 1885, by Lucae [13]. Körner's initial criteria [14] to distinguish acquired from congenital cholesteatoma were revived half a century later by Derlacki and Clemis [15] who reintroduced the concept of congenital cholesteatoma in 1965. They proposed that congenital cholesteatoma be defined as a pearly white mass behind an intact tympanic membrane in the absence of history of otitis or otorrhea, tympanic membrane
Primary acquired cholesteatoma
The pathophysiology of acquired cholesteatoma is similarly controversial. As previously eluded to, the precise pathogenesis of cholesteatoma has been debated for more than two centuries. Four predominant theories have fueled the debate: (1) invagination, (2) basal cell hyperplasia or papillary ingrowth, (3) metaplasia, and (4) epithelial invasion.
The invagination theory is currently regarded as one of the primary mechanism of the formation of primary acquired attic cholesteatoma. Anatomic or
Secondary acquired cholesteatoma
Secondary acquired cholesteatoma has been described to occur as the result of the migration of tympanic membrane epidermis into the middle ear at the site of a marginal perforation or as the result of the implantation of viable keratinocytes into the middle ear cleft. The implantation occurs during a blast injury to the tympanic membrane leaving keratinocytes behind a healed perforation, at the site of a temporal bone fracture, or as the result of an iatrogenic introduction of these cells. The
Mechanism of bone destruction
The ongoing debate on the pathogenesis of cholesteatoma is paralleled by the ongoing research to help elucidate the mechanism of expansion, bone destruction and invasion seen in middle ear cholesteatoma. Two predominant mechanisms are believed to account for the osteolysis seen in middle ear cholesteatoma: pressure-induced bone resorption and enzymatic dissolution of bone by cytokine-mediated inflammation. Pressure necrosis initially described by Steinbrügge in 1879 and Walsh in 1951, and
Summary
The pathophysiology of cholesteatoma continues to be debated widely. Cholesteatoma is classified as congenital or acquired. Recent studies appear to favor a possible common origin and overlap in the pathophysiology between both entities. Despite the growing evidence that the genesis, expansion, and progression of cholesteatoma is a complex interaction between anatomic, inflammatory, and regulatory factors of cellular proliferation and differentiation, the exact mechanism responsible for the
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2022, Annals of Medicine and SurgeryCitation Excerpt :A cholesteatoma consists of a mass of stratified keratinising squamous epithelium in the ear [1]. The aetiology of cholesteatoma is often debated, but acquired cholesteatoma is considered as a lesion that arises from the lateral epithelium of the tympanic membrane, which then grows as a self-perpetuating mass into the middle ear [2]. This lesion can activate the local osteoclasts and lead to serious local tissue destruction.
Endoscopic Management of Primary Acquired Cholesteatoma
2021, Otolaryngologic Clinics of North AmericaCitation Excerpt :There are several theories on the pathogenesis of primary acquired cholesteatoma. These include (1) invagination, (2) basal cell hyperplasia, (3) metaplasia, and (4) epithelial invasion.6 More recently, 2 new theories have been proposed: mucosal traction and selective epitympanic dysventilation theory.
The outcomes of endoscopic approach for attic cholesteatoma: Underwater continuous drilling versus traditional intermittent drilling
2021, Journal of Laryngology and Otology