A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction

Jackler, Robert K.; Maria, Peter L. Santa; Varsak, Yasin Kürşad; Nguyen, Anh; Blevins, Nikolas H.

doi:10.1002/lary.25261

Cited by 54 publications

(55 citation statements)

References 107 publications

(117 reference statements)

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“…Furthermore, a similarity was found in the CK distribution of the external canal skin and cholesteatoma in contrast to the middle ear epithelium [12,22]. Nevertheless, this theory could not explain the occurrence of cholesteatoma in ears without TM perforation which is a common situation [23]. …”

Section: Discussionmentioning

confidence: 99%

“…Originally described by Wittmack, in 1933 and it remained the most widely accepted until now [5,23]. This theory assumed that primary acquired cholesteatoma was preceded by retraction pocket in the region of pars flaccida caused by negative pressure of the middle ear due to variety of factors like Eustachian tube malfunction, habitual sniffing, or small mastoid volume [26-28].…”

Section: Discussionmentioning

confidence: 99%

“…The theory was supported experimentally by formation of cholesteatoma in 75% of Mongolian gerbils following bilateral Eustachian tube obstruction by electrocautery and also by higher incidence of cholesteatoma among patients with cleft palate in whom the Eustachian tube was malfunctioning [29,30]. Recently, Jackler et al [23] criticized the invagination theory in several respects. Their criticism was depending on observing the results of other studies and can be summarized in the following points: first, the occurrence of cholesteatoma was not reduced after cleft palate repair or insertion of ventilation tubes in cleft palate patients [31,32].…”

Section: Discussionmentioning

confidence: 99%

“…Fourth, in a study done by Roland et al [34], the insertion of ventilation tympanostomy tubes was not effective in lowering the incidence of cholesteatoma in children. Finally that the negative middle ear pressure, although it can lead to TM retraction, it doesn’t have enough power to maintain further progression of cholesteatoma pouch [23]. …”

Section: Discussionmentioning

confidence: 99%

“…The most recent hypothesis for cholesteatoma pathogenesis was suggested by Jackler et al [23] in 2015. The main principle of this theory is based upon observing the mucosal migration on the inner surface of the TM and mucociliary movement of middle ear mucosa.…”

Section: Discussionmentioning

confidence: 99%

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Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

Hamed

Nakata

Sayed

et al. 2016

Clin Exp Otorhinolaryngol

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Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords ‘aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.’ In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

Hamed

Nakata

Sayed

et al. 2016

Clin Exp Otorhinolaryngol

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Characteristics of Otologic Disease Among Patients With Primary Ciliary Dyskinesia

Goutaki

Lam

Alexandru

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceOtologic disease is common among people with primary ciliary dyskinesia (PCD), yet little is known about its spectrum and severity.ObjectiveTo characterize otologic disease among participants with PCD using data from the Ear-Nose-Throat Prospective International Cohort.Design, Setting, and ParticipantsThis cross-sectional analysis of baseline cohort data from February 2020 through July 2022 included participants from 12 specialized centers in 10 countries. Children and adults with PCD diagnoses; routine ear, nose, and throat examinations; and completed symptom questionnaires at the same visit or within 2 weeks were prospectively included.ExposuresPotential risk factors associated with increased risk of ear disease.Main Outcomes and MeasuresThe prevalence and characteristics of patient-reported otologic symptoms and findings from otologic examinations, including potential factors associated with increased risk of ear inflammation and hearing impairment.ResultsA total of 397 individuals were eligible to participate in this study (median [range] age, 15.2 [0.2-72.4] years; 186 (47%) female). Of the included participants, 204 (51%) reported ear pain, 110 (28%) reported ear discharge, and 183 (46%) reported hearing problems. Adults reported ear pain and hearing problems more frequently when compared with children. Otitis media with effusion—usually bilateral—was the most common otoscopic finding among 121 of 384 (32%) participants. Retracted tympanic membrane and tympanic sclerosis were more commonly seen among adults. Tympanometry was performed for 216 participants and showed pathologic type B results for 114 (53%). Audiometry was performed for 273 participants and showed hearing impairment in at least 1 ear, most commonly mild. Season of visit was the strongest risk factor for problems associated with ear inflammation (autumn vs spring: odds ratio, 2.40; 95% CI, 1.51-3.81) and age 30 years and older for hearing impairment (41-50 years vs ≤10 years: odds ratio, 3.33; 95% CI, 1.12-9.91).Conclusion and RelevanceIn this cross-sectional study, many people with PCD experienced ear problems, yet frequency varied, highlighting disease expression differences and possible clinical phenotypes. Understanding differences in otologic disease expression and progression during lifetime may inform clinical decisions about follow-up and medical care. Multidisciplinary PCD management should be recommended, including regular otologic assessments for all ages, even without specific complaints.

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Developmental aspects of the tympanic membrane: Shedding light on function and disease

Mozaffari

Jiang

Tucker

2019

Genesis

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Summary The ear drum, or tympanic membrane (TM), is a key component in the intricate relay that transmits air‐borne sound to our fluid‐filled inner ear. Despite early belief that the mammalian ear drum evolved as a transformation of a reptilian drum, newer fossil data suggests a parallel and independent evolution of this structure in mammals. The term “drum” belies what is in fact a complex three‐dimensional structure formed from multiple embryonic cell lineages. Intriguingly, disease affects the ear drum differently in its different parts, with the superior and posterior parts being much more frequently affected. This suggests a key role for the developmental details of TM formation in its final form and function, both in homeostasis and regeneration. Here we review recent studies in rodent models and humans that are beginning to address large knowledge gaps in TM cell dynamics from a developmental biologist's point of view. We outline the biological and clinical uncertainties that remain, with a view to guiding the indispensable contribution that developmental biology will be able to make to better understanding the TM.

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A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction

Cited by 54 publications

References 107 publications

Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

Pathogenesis and Bone Resorption in Acquired Cholesteatoma: Current Knowledge and Future Prospectives

Characteristics of Otologic Disease Among Patients With Primary Ciliary Dyskinesia

Developmental aspects of the tympanic membrane: Shedding light on function and disease

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