Newer perspectives on the pathology of chronic otitis media

The application of newer research techniques had led to re-evaluation of the pathology and pathogenesis of chronic suppurative otitis media (CSOM). The infectious-inflammatory process with CSOM and with cholesteatoma is emerging as the major factor responsible for both soft tissue scarring and bone destruction. There is no evidence that pressure plays a role in cholesteatomatous bone resportion. Experimental and clinical evidence favors immigration of external canal skin as the most important mode of cholesteatoma formation. The evidence for attic retraction cholesteatoma is suggestive but less conclusive.