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Acquired cholesteatoma pathogenesis: stepwise explanations

Published online by Cambridge University Press:  16 February 2010

L Louw
L Louw*
Affiliation:
Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
*
Address for correspondence: Prof Louise Louw, Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Box 339G42 Bloemfontein, 9300, South Africa. Fax: 27 51 4053493 E-mail: gnanll.md@ufs.ac.za
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Abstract

Background:

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.

Keywords

CholesteatomaMiddle EarHyperplasiaMetaplasiaSquamousEpithelium
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 6 , June 2010 , pp. 587 - 593
Copyright
Copyright © JLO (1984) Limited 2010

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