Article

Etiology of otic cholesteatoma

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Abstract

Cholesteatoma is a cystic structure characterized by presence of squamous epithelium producing keratin substituting or recovering the normal mucosa in the groove of middle ear and petrous apex and may to be caused by irreversible hypoacusia, bone destruction and severe complications due to its expansive growth. Typically the cholesteatomas are described as congenital and acquired. The etiology of its formation is multifactor and still remains a subject not very clear and controversial. Different theories are reported to explain the congenital cholesteatoma, the transition of a retraction pocket until the appearance of primary acquired cholesteatoma and other on the genesis of the secondary acquired cholesteatoma. Presence of some cytokines in cholesteatoma is described inducing to hyperproliferation and not coordinated of keratinocytes of the external auditory meatus and the pars flaccida more aggressive in the pediatric acquired cholesteatoma playing a fundamental role in the proliferation and in apoptosis of keratinocyte. In a sample of choleastomatous tissue in vitro culture has been recently identified that the α-TNF stimulates the production of IL-8. It is interesting to offer present review on the etiology of cholesteatoma that still is under research and a challenge for otologists due to its high relapses incidence and potential complications.

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Article
Retraction pockets can lead to hearing loss and cholesteatoma. Distinguishing stable from progressive disease is challenging to any otologist. The management of retraction pockets is a contentious issue with present treatment options often plagued with recurrence. The purpose of this article is to summarize recent developments in the aetiology of retraction pockets of the pars tensa, its diagnostic and management problems and to define possible future therapeutic options.
Article
The relationship of pars flaccida retraction with epitympanic aeration and mastoid size is ill-defined. Both pars flaccida retraction and small mastoid size are traits of nearly all clinical entities of otitis media. To determine, in clinically normal specimens, the relationship of pars flaccida retraction with mastoid pneumatisation and epitympanic aeration. Post-mortem anatomical dissection of 41 bequeathed adult crania without clinical otitis. Pars flaccida retractions were viewed with an operating microscope and judged using Sade's classification. Mastoid sizes were determined radiographically (by plain Law lateral images). Ten crania, five with the largest mastoids and five with the smallest mastoids, were studied by computed tomography. No specimen had a retraction worse than Sade grade two (i.e. retracted onto the neck of the malleus). Retractions were unrelated to the extent of mastoid pneumatisation. All epitympani were found to be normal on both anatomical dissection and computed tomography imaging. Pars flaccida retraction is probably related to prior, presumably transient, non-aeration of Prussak's space.