Cholesteatoma Pearls: Practical Points and Update

Abstract

The European Academy of Otology and Neurotology in collaboration with the Japanese Otological Society (EAONO/JOS) recently produced a joint consensus document outlining the definitions, classification and staging of middle ear cholesteatoma. The goals were to provide terminologies in the description of cholesteatoma, classify cholesteatoma into distinct categories to facilitate the comparison of surgical outcomes and to provide a staging system that reflects the severity, difficulty of complete removal and restoration of normal function. Cholesteatoma is considered a benign, expanding and destructive epithelial lesion of the temporal bone that is the result of a multifactorial process. If undetected and left treated, cholesteatoma may lead to significant complications including hearing loss, temporal bone destruction and cranial invasion. Recent advances in imaging modalities have allowed for high sensitivity and specificity in identifying the presence of cholesteatoma. Despite these advances, deficiencies exist around the world with access to health care facilities meaning cholesteatoma remains a serious and challenging entity to manage whether found within the pediatric or adult population. Proper diagnosis and management of each form of cholesteatoma is achieved by a thorough understanding of the etiology, classification, clinical presentation and histology, thereby facilitating prevention, early detection and appropriate treatment.

Readout-Segmented Echo-Planar DWI for the Detection of Cholesteatomas: Correlation with Surgical Validation

“…Non-EPI-DWI is known to provide less image distortion and artifacts than other DWI techniques. 23 Nevertheless, the acquisition time for non-EPI-DWI and EPI-DWI can be quite different. We found acquisition times between 3 and 6 minutes for 1 b-value with non-EPI-DWI in the literature, 21 and some studies did not indicate the acquisition time.…”

Association of Matrix Metalloproteinase-2 mRNA Expression with Subtypes of Pediatric Cholesteatoma

“…Cholesteatoma is a clinically heterogeneous disease, with some patients showing spontaneous regression [12], while others There is growing evidence that host inflammatory responses contribute to cholesteatoma progression. Upregulation of several inflammatory cytokines has been shown to predict worse prognosis [14]. MMP2 is a core member of the MMP family, consisting of proteolytic enzymes that degrade the extracellular matrix, and is known to play an important role in cholesteatoma progression via bone destruction and tumor cell invasion [9].…”

Cholesteatoma of maxillary sinus simulating neoplasia: A rare case report

“… Remark and Bucy (1854) stated that they arise from misplaced epithelial rests during the embryonic stage Wendt (1873) proposed that in response to infection, nonkeratinizing squamous epithelium lining the cavity undergoes metaplastic change and produces keratin Habermann (1888) theorized that migration of keratinizing squamous epithelium in an area where it is not usually found Lange (1925), Reudi (1978)[ 4 5 ] proposed that papillations, pseudopods, or microcysts filled with keratin formed in the basal cell layer of the pars flaccida epithelium, invade the subepithelium of Prussack's space Ewing (1928) stated that during previous trauma and after nasal or sinus surgery, it arises secondary to the direct entry of epithelium Wittmack (1933)[ 4 5 ] stated poor aeration of epitympanic space and the structures around it are drawn medially by retraction forming a retraction pocket. It causes negative pressure that restricts the normal migratory pattern of the tympanic membrane, thereby losing its ability of self-cleaning and enhancing keratin accumulation The most recent theory proposed by Jackler et al .…”

“…It causes negative pressure that restricts the normal migratory pattern of the tympanic membrane, thereby losing its ability of self-cleaning and enhancing keratin accumulation The most recent theory proposed by Jackler et al . (2015)[ 5 ] described the mucosal migration onto the inner surface of the tympanic membrane and the interaction between the mucociliary movement of middle ear mucosa leads to the formation of the epithelial pouch which leads to form cholesteatoma. …”

“…Lange (1925), Reudi (1978)[ 4 5 ] proposed that papillations, pseudopods, or microcysts filled with keratin formed in the basal cell layer of the pars flaccida epithelium, invade the subepithelium of Prussack's space…”