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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: [email protected]
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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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References

1 Olszewska, E, Wagner, M, Bernal-Sprekelson, M, Ebmeyer, J, Dazert, S, Hildmann, H et al. Etiopathogenesis of cholesteatoma. Eur Arch Otorhinolaryngol 2004;261:6–24CrossRefGoogle ScholarPubMed
2 de Azevedo, AF, Pinto, CG, de Souza, NJA, Greco, DB, Goncalves, DU. Sensorineural hearing loss in chronic suppurative otitis media with or without cholesteatoma. Rev Bras Otorrinolaringol 2007;73:671–4Google ScholarPubMed
3 McHugh, TP. Intracranial cholesteatoma; case report and review. J Emerg Med 2007;32:375–9CrossRefGoogle ScholarPubMed
4 Quaranta, N, Cassano, M, Quaranta, A. Facial paralysis associated with cholesteatoma: a review of 13 cases. Otol Neurotol 2007;28:405–7CrossRefGoogle ScholarPubMed
5 Migirov, L, Bendet, E, Kronenberg, J. Cholesteatoma invasion into the internal auditory canal. Eur Arch Otorhinolaryngol 2009;266:657–62CrossRefGoogle ScholarPubMed
6 Tos, M. Manual of Middle Ear Surgery. Stuttgart, New York: Thieme, 1993Google Scholar
7 Tos, M. Incidence, etiology and pathogenesis of cholesteatoma in children. Adv Otohinolaryngol, 1988;40:110–7CrossRefGoogle Scholar
8 Chole, RA, Sudhoff, HH. Chronic otitis media, mastoiditis and petrositis. In: Cummings, CW. Otolaryngology: Head and Neck Surgery, 4th edn. Philadelphia, Pennsylvania: Mosby, Elsevier, 2005;4:2988–3003Google Scholar
9 Persuad, R, Hajioff, D, Trinidale, A, Khemani, S, Battacharyya, MN, Papadimitriou, N et al. Evidence-based review of aetiopathogenic theories of congenital and acquired cholesteatoma. J Laryngol Otol 2007;121:1013–1019CrossRefGoogle Scholar
10 Chang, P, Kim, S. Cholesteatoma: diagnosing the unsafe ear. Aust Fam Physician 2008;37:631–8Google ScholarPubMed
11 Dornelles, C, da Costa, SS, Meurer, L, Scheiweger, C. Some considerations about acquired adult and pediatric cholesteatomas. Rev Bras Otorrinolaringol 2005;4:536–46CrossRefGoogle Scholar
12 Dornelles, C, da Costa, SS, Meurer, L, Schweiger, C. Correlation of cholesteatoma perimatrix thickness with patient's age. Rev Bras Ortorrinolaryngol 2005;6:792–7CrossRefGoogle Scholar
13 Oktay, MF, Cureoglu, S, Schachern, PA, Paparella, MM, Kariya, S, Fukushima, H. Tympanic membrane changes in central tympanic membrane perforations. Am J Otolaryngol Head Neck Med Surg 2005;26:393–7Google ScholarPubMed
14 Dornelles, C, Meurer, L, de Costa, SS, Schweiger, C. Histological description of acquired cholesteatomas: comparison between children and adults. Braz J Otorrinolaringol 2006;72:641–8Google ScholarPubMed
15 Sudhoff, H, Tos, M. Pathogenesis of sinus cholesteatoma. Eur Arch Otorhinolaryngol 2007;264:137–43CrossRefGoogle ScholarPubMed
16 Huisman, MA, de Heer, E, Dijke, PT, Grote, JJ. Transforming growth factor β and wound healing in human cholesteatoma. Laryngoscope 2007;118:94–8CrossRefGoogle Scholar
17 Louw, L. The keloid phenomenon: progress toward a solution. J Clin Anatomy 2007;20:3–14CrossRefGoogle ScholarPubMed
18 Chole, RA, Faddis, BT. Evidence for microbial biofilms in cholesteastomas. Arch Otolaryngol Head Neck Surg 2002;128:1129–33CrossRefGoogle Scholar
19 Post, JC, Hiller, NL, Nistico, L, Stoodley, P, Ehrlich, GD. The role of biofilms in otolaryngologic infections: update 2007. Curr Opin Otolaryngol Head Neck Surg 2007;15:347–51CrossRefGoogle ScholarPubMed
20 Macassey, E, Dawes, P. Biofilms and their role in otorhinolaryngological disease. J Laryngol Otol 2008;122:1273–8CrossRefGoogle ScholarPubMed
21 Mishiro, Y, Sakagami, M, Kitahara, T, Kondoh, K, Okumura, S. The investigation of the recurrence rate of cholesteatoma using Kaplan-Meier survival analysis. Otol Neurotol 2008;29:803–6CrossRefGoogle ScholarPubMed
22 Mustafa, A, Heta, A, Kastrai, B, Dreshaj, SH. Complications of chronic otitis media with cholesteatoma during a 10-year period in Kosovo. Eur Arch Otorhinolaryngol 2008;265:1477–82CrossRefGoogle ScholarPubMed
23 Mustafa, A, Hysenaj, Q, Latifi, X, Ukimeraj, L, Thaci, H, Heta, A et al. Managing chronic otitis media with cholesteatoma report of 223 patients seen in a 5-year period. Niger J Med 2008;17:20–4CrossRefGoogle ScholarPubMed
24 Becker, W, Naumann, HH, Pfaltz, CR. Ear, Nose and Throat Diseases, 2nd edn. New York: Thieme Medical Publishers, 1993Google Scholar
25 Tos, M. Incidence, etiology and pathogenesis of cholesteatoma in children. Adv Otorhinolaryngol 1988;40:110–7Google ScholarPubMed
26 Ruah, CB, Schachem, PA, Paparella, MM, Zeltermann, D. Mechanisms of retraction pocket formation in the pediatric tympanic membrane. Arch Otolaryngol Head Neck Surg 1992;118:1298–305CrossRefGoogle ScholarPubMed
27 Sade, J. The buffering effect of middle ear negative pressure by retraction of the pars tensa. Am J Otol 2000;21:20–3CrossRefGoogle ScholarPubMed
28 Seibert, JW, Danner, CJ. Eustachian tube function and the middle ear. Otolaryngol Clin North Am 2006;39:1221–35CrossRefGoogle ScholarPubMed
29 Ramakrishnan, Y, Kotecha, A, Bowdler, DA. A review of retraction pockets: past, present and future management. J Laryngol Otol 2007;121:521–5CrossRefGoogle ScholarPubMed
30 Ohta, S, Sakagami, M, Suzuki, M, Mishiro, Y. Eustachian tube function and habitual sniffing in middle ear cholesteatoma. Otol Neurol 2009;30:48–53CrossRefGoogle ScholarPubMed
31 Homøe, P, Rosberg, J. Family cluster of cholesteatoma. J Laryngol Otol 2007;121:65–7CrossRefGoogle ScholarPubMed
32 Prinsley, P. Familial cholesteatoma in East Anglia, UK. J Laryngol Otol 2009;123:294–7CrossRefGoogle ScholarPubMed
33 Ecsedi, S, Rákosy, Z, Vizkeleti, L, Juhász, A, Sziklai, I Adány, R et al. Chromosomal imbalances are associated with increased proliferation and might contribute to bone destruction in cholesteatomas. Otolaryngol Head Neck Surg 2008;139:635–40CrossRefGoogle Scholar
34 Kemppainen, HO, Puhakka, HJ, Laippala, PJ, Sipilä, MM, Manninen, MP, Karma, PH. Epidemiology and etiology of middle ear cholesteatoma. Acta Otolaryngol 1999;119:568–72Google ScholarPubMed
35 Osma, U, Cureoglu, S, Hosoglu, S. The complications of chronic otitis media: report of 93 cases. J Laryngol Otol 2000;114:97–100CrossRefGoogle ScholarPubMed
36 Tos, M. Pathogenesis of sinus and tensa retraction cholesteatoma. In: Sanna, M, ed. Cholesteatoma and Mastoid Surgery. Rome: CIC Edizioni Internazionali, 1997;3–8Google Scholar
37 Mills, R. Cholesteatoma behind an intact tympanic membrane in adult life: congenital or acquired? J Laryngol Otol 2009;124:488–91CrossRefGoogle Scholar
38 Sudhoff, H, Tos, M. Pathogenesis of attic cholesteatoma: clinical and immunohistochemical support for combination of retraction theory and proliferation theory. Am J Otol 2000;21:786–92Google ScholarPubMed
39 Kultz, JW, Brackmann, DE. Attic cholesteatoma. Ear Nose Throat J 2007;86:588CrossRefGoogle Scholar
40 Adunka, O, Gstoettner, W, Knecht, R, Kiener, AC. Expression of hypoxia inducible factor 1 alpha and Von Hippel Lindau protein in human middle ear cholesteatoma. Laryngoscope 2003;113:1210–5CrossRefGoogle Scholar
41 Olszewska, E, Chodynicki, S, Chyczewski, L. Apoptosis in the pathogenesis of cholesteatoma in adults. Eur Arch Otorhinolaryngol 2006;263:409–13CrossRefGoogle ScholarPubMed
42 Ong, CA, Narayanan, P, Godbole, S, Raman, R. Epithelial migration in open mastoidectomy cavities. Asian J Surg 2007;30:57–9CrossRefGoogle ScholarPubMed
43 Kim, HJ, Tinling, SP, Chole, RA. Increased proliferation and migration of epithelium in advancing experimental cholesteatomas. Otol Neurol 2002;23:840–4CrossRefGoogle ScholarPubMed
44 Kim, HJ, Tinling, SP, Chole, RA. Expression patterns of cytokeratins in cholesteatomas: evidence of increased migration and proliferation. J Korean Med Sci 2002;17:381–8CrossRefGoogle ScholarPubMed
45 Kim, HJ, Tinling, SP, Chole, RA. Expression patterns of cytokeratins in retraction pocket cholesteatomas. Laryngoscope 2001;11:1032–6CrossRefGoogle Scholar
46 Olszewska, E, Lautermann, J, Koc, C, Schwaab, M, Dazert, S, Hildmann, H et al. Cytokeratin expression pattern in congenital and acquired pediatric cholesteatoma. Eur Arch Otorhinolaryngol 2005;262:731–6CrossRefGoogle ScholarPubMed
47 Olszweska, E, Sudhoff, H. Comparative cytokeratin distribution patterns in cholesteatoma epithelium. Histol Histopathol 2007;22:37–42Google Scholar
48 Park, HR, Min, SK, Min, SY, Jun, J, Seo, J, Kim, HJ. Increased expression of p63 and survivin in cholesteatomas. Acta Otolaryngol 2009;129:268–72CrossRefGoogle ScholarPubMed
49 Murphy, GC, March, A. Tympanic membrane cholesteatoma. Otorhinolaryngol Head Neck 2008;138:686–7CrossRefGoogle ScholarPubMed
50 Louw, L, Claassen, A. HPV-induced recurrent laryngeal papillomatosis: fatty acid role-players. Asia Pac J Clin Nutr 2008;17:208–11Google ScholarPubMed
51 Nagai, T, Suganuma, T, Ide, S, Shimoda, H, Kato, S. Confirmation of mucin in lymphatic vessels of acquired cholesteatoma. Eur Arch Otorhinolaryngol 2006;263:361–4CrossRefGoogle ScholarPubMed
52 Sudhoff, H, Dazert, S, Gonzales, AM, Borkowski, G, Park, SY, Baird, A et al. Angiogenesis and angiogenic growth factors in middle ear cholesteatoma. Am J Otol 2000;21:793–8Google ScholarPubMed
53 Smith, JA, Danner, CJ. Complications of chronic otitis media and cholesteatoma. Otolaryngol Clin North Am 2006;39:1237–55CrossRefGoogle ScholarPubMed
54 Vikram, BK, Khaja, N, Udayashankar, SG, Venkatesha, BK, Manjunath, D. Clinico-epidemiological study of complicated and uncomplicated chronic suppurative otitis media. J Laryngol Otol 2007;122:442–6CrossRefGoogle ScholarPubMed
55 Ekambar, C, Reddy, E, Goodyear, P, Ghosh, S, Lesser, T. Intratympanic membrane cholesteatoma: a rare incidental finding. Eur Arch Otorhinolaryngol 2006;263:1061–4Google Scholar
56 Isaacson, G. Diagnosis of pediatric cholesteatoma. Pediatrics 2007;120:603–8CrossRefGoogle ScholarPubMed
57 Borgstein, J, Stoop, E, Halim, A, Feenstra, L. The extraordinary healing properties of the pediatric tympanic membrane: a study of atelectasis in the pediatric ear. Int J Pediatric Otorhinolaryngol 2008;72:1789–93CrossRefGoogle ScholarPubMed
58 Antunes, ML, Fukuda, Y, de Oliveira Penido, N, Ferreira, R. Effect of trans-retinoic acid in the inhibition of cholesteatoma in guinea pigs. Rev Bras Otorrinolaringol 2008;74:53–60CrossRefGoogle ScholarPubMed
59 Vitale, RF, Ribeiro F de, AQ. The role of tumor necrosis factor-alpha in bone resorption present in middle ear cholesteatoma. Rev Bras Otorrinolaringol 2007;73:123–7CrossRefGoogle ScholarPubMed
60 Olszewska, E, Olszweska, S, Borzym-Kluczyk, M, Zwierz, K. Role of N-acetyl-beta-D-hexosaminidase in cholesteatoma tissue. Acta Biochim Pol 2007;54:365–70CrossRefGoogle ScholarPubMed
61 Sade, J, Ar, A. Middle ear and auditory tube: middle ear clearance, gas exchange, and pressure regulation. Otolaryngol Head Neck 1997;116:499–524CrossRefGoogle ScholarPubMed