No Evidence for Mucosal Migration Theory of Cholesteatoma Formation

Study design: Comparative study of 73 human temporal bones.

Setting: Otopathology Laboratory in the Department of Otolaryngology, University of Minnesota, Minneapolis.

Synopsis: The temporal bones were separated into five groups: 1. cholesteatoma; 2. chronic otitis media without cholesteatoma (COM); 3. retraction pockets (RPs); 4. cystic fibrosis (CF); and 5. a control group with no middle ear disease. In the epitympanum: There were no differences in the number or distribution of ciliated cells between the pars tensa and pars flaccida of the tympanic membrane among the groups. The mean number of ciliated cells at the lateral epitympanum’s mucosal lining and the malleus and incus’s lateral surface were significantly reduced in bones with cholesteatoma.

There were fewer ciliated cells in the RP group compared with non-diseased ears; when present, they were usually located at the lateral wall of the epitympanum, not on the ossicles. In the tympanic membrane: The mean number of ciliated cells was decreased in the cholesteatoma compared to RP groups. In the protympanum: Ciliated cells were plentiful for all four conditions studied.

The mean number of ciliated cells in the lateral wall of the protympanic space was decreased in the group with cholesteatoma and COM compared to RP, CF, and control groups. Some ciliated cells were found at the tympanic membrane’s anterior annulus and at the posterior portion of the handle of the malleus, in contact with the tympanic membrane. The epithelium covering the ossicles’ lateral face at the epitympanum and at the medial surface of the tympanic membrane consisted of flat simple squamous epithelium.

Citation: Pauna HF, Monsanto RC, Schachern P, et al. Evidence against the mucosal traction theory in cholesteatoma. Laryngoscope. 2018;128:1663–1667.