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Updated: Feb 21, 2026
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Evidence against the mucosal traction theory in cholesteatoma
Henrique F Pauna1,2, Rafael C Monsanto1,3,4, Patricia Schachern1
1Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.
Objectives:
To investigate the distribution of ciliated epithelium in the human middle ear and its potential role in the formation of cholesteatoma.
Study Design:
Comparative human temporal bone study.
Methods:
We selected temporal bones from 14 donors with a diagnosis of cholesteatoma, 15 with chronic otitis media without retraction pockets, 14 with chronic otitis media with retraction pockets, 14 with cystic fibrosis (CF), and 16 controls. We mapped the distribution of the ciliated cells in the mucosal lining of the middle ear and tympanic membrane using three-dimensional reconstruction analysis, and counted the number of ciliated cells in the middle ear mucosa.
Results:
Ciliated cells are extremely sparse in the epithelial lining of the lateral surface of the ossicles in the epitympanum and the medial surface of the tympanic membrane. Furthermore, there is a significant decrease in the number of ciliated cells in these areas in temporal bones with cholesteatoma, chronic otitis media, chronic otitis media with retraction pockets, and CF compared to controls. Ciliated cells most commonly are located at the hypotympanum and the Eustachian tube opening but not the tympanic membrane or epitympanum.
Conclusion:
The paucity of ciliated epithelial cells on the medial side of the tympanic membrane and the lateral surface of the ossicles in the epitympanum in cases with cholesteatoma and/or chronic otitis media do not support the mucosal migration theory of cholesteatoma formation.
Level Of Evidence:
NA. Laryngoscope, 128:1663-1667, 2018.
