Evidence against the mucosal traction theory in cholesteatoma

Henrique F. Pauna, Rafael C. Monsanto, Patricia Schachern, Michael M. Paparella, Richard A. Chole, Sebahattin Cureoglu

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objectives: To investigate the distribution of ciliated epithelium in the human middle ear and its potential role in the formation of cholesteatoma. Study Design: Comparative human temporal bone study. Methods: We selected temporal bones from 14 donors with a diagnosis of cholesteatoma, 15 with chronic otitis media without retraction pockets, 14 with chronic otitis media with retraction pockets, 14 with cystic fibrosis (CF), and 16 controls. We mapped the distribution of the ciliated cells in the mucosal lining of the middle ear and tympanic membrane using three-dimensional reconstruction analysis, and counted the number of ciliated cells in the middle ear mucosa. Results: Ciliated cells are extremely sparse in the epithelial lining of the lateral surface of the ossicles in the epitympanum and the medial surface of the tympanic membrane. Furthermore, there is a significant decrease in the number of ciliated cells in these areas in temporal bones with cholesteatoma, chronic otitis media, chronic otitis media with retraction pockets, and CF compared to controls. Ciliated cells most commonly are located at the hypotympanum and the Eustachian tube opening but not the tympanic membrane or epitympanum. Conclusion: The paucity of ciliated epithelial cells on the medial side of the tympanic membrane and the lateral surface of the ossicles in the epitympanum in cases with cholesteatoma and/or chronic otitis media do not support the mucosal migration theory of cholesteatoma formation. Level of Evidence: NA. Laryngoscope, 128:1663–1667, 2018.

Original languageEnglish (US)
Pages (from-to)1663-1667
Number of pages5
Issue number7
StatePublished - Jul 2018

Bibliographical note

Funding Information:
This project was funded by NIH NIDCD U24 DC011968; the International Hearing Foundation, Starkey Hearing Foundation, and Lions 5M International. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Publisher Copyright:
© 2017 The American Laryngological, Rhinological and Otological Society, Inc.


  • Ciliated cells
  • cholesteatoma
  • cystic fibrosis
  • histopathological on chronic ear diseases
  • retraction pockets


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