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Updated: Oct 12, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Bacterial and Fungal Infections Promote the Bone Erosion Progression in Acquired Cholesteatoma Revealed by
Hua Jiang1, Chengpeng Wu2, Jingjie Xu2
1Department of Otolaryngology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Abstract:
An acquired cholesteatoma generally occurs as a consequence of otitis media and eustachian tube dysfunction. Patients with acquired cholesteatoma generally present with chronic otorrhea and progressive conductive hearing loss. There are many microbes reportedly associated with acquired cholesteatoma. However, conventional culture-based techniques show a typically low detection rate for various pathogenetic bacteria and fungi. Metagenomic next-generation sequencing (mNGS), an emerging powerful platform offering higher sensitivity and higher throughput for evaluating many samples at once, remains to be studied in acquired cholesteatoma. In this study, 16 consecutive patients from January 2020 to January 2021 at the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU) were reviewed. We detected a total of 31 microbial species in patients, mNGS provided a higher detection rate compared to culture (100% vs. 31.25%, p = 0.000034). As the severity of the patient's pathological condition worsens, the more complex types of microbes were identified. The most commonly detected microbial genus was Aspergillus (9/16, 56.25%), especially in patients suffering from severe bone erosion. In summary, mNGS improves the sensibility to identify pathogens of cholesteatoma patients, and Aspergillus infections increase bone destruction in acquired cholesteatoma.
Insights
Metagenomic next-generation sequencing (mNGS) significantly improves pathogen detection in acquired cholesteatoma compared to traditional methods. This advanced technique identified Aspergillus as a common pathogen, particularly in severe cases with bone erosion.
Area of Science:
- Otolaryngology
- Microbiology
- Genomics
Background:
- Acquired cholesteatoma often results from otitis media and eustachian tube dysfunction.
- Patients typically experience chronic otorrhea and progressive conductive hearing loss.
- Conventional culture methods have limitations in detecting various pathogens in cholesteatoma.
Purpose of the Study:
- To evaluate the efficacy of metagenomic next-generation sequencing (mNGS) for pathogen detection in acquired cholesteatoma.
- To compare the detection rates of mNGS with conventional culture-based techniques.
- To identify microbial species associated with acquired cholesteatoma and their correlation with disease severity.
Main Methods:
- Retrospective review of 16 acquired cholesteatoma patients from January 2020 to January 2021.
- Detection of microbial species using metagenomic next-generation sequencing (mNGS).
- Comparison of mNGS results with conventional culture-based detection rates.
Main Results:
- mNGS achieved a 100% detection rate for microbial species, significantly higher than culture methods (31.25%, p = 0.000034).
- A total of 31 microbial species were detected, with increased complexity correlating with disease severity.
- The genus Aspergillus was the most frequently detected (56.25%), particularly in patients with severe bone erosion.
Conclusions:
- mNGS offers superior sensitivity for identifying pathogens in acquired cholesteatoma.
- Aspergillus infection is associated with increased bone destruction in acquired cholesteatoma.
- mNGS is a valuable tool for understanding the complex microbial landscape of acquired cholesteatoma.
