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KMID : 0371919880010010095
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Journal of Wonju College of Medicine
1988 Volume.1 No. 1 p.95 ~ p.110
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Morphological Studies for Middle Ear Cholesteatoma
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Abstract
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Chronic otitus media represents one of the most prevalent forms of infectilous disease. It is a worldwide health problem with is still prevalent in the modern antibiotic era. Especially cholesteatomatous otitis media destroys the surrounding bony structure and may cause danggerous complication such as labyrinthitis, meningitis, brain abscess and facial palsy. The clinical significance of the cholesteatoma lies in its association with progressive bone destruction which requires major middle ear surgery for eradication of the infection.
Otologists have been engaged in a search for answers concenrning the pathogenesis and pathophysiology of cholesteatoma since the initial descriptions of Cruveilheir and Muller, and much information has been gathered over the past 140 years.
Regarding the pathogenesis of cholesteatoma, the prevailing theories are congenital, t?aumatic, metaplasia and migration theory. Most otologists today believe that migration explains he pathogenesis of middle ear cholesteatoma that the skin of ear canal grows medially into the middle ear throgh the perforated drum to form an epidermal sac.
The aim of this study was to clarify the structure of the various elements that compose the cholesteatoma romoved at operation and to elucidate the possible mechanism of this desease by a morpholgic analysis.
The authors analysed 20 operated cases of cholesteatomatous otitis media with the histopatholgica and the ultrastructural features.
The results obtained were as follows:
1. As well as ear canal epidermis, cholesteatoma matrix consisted of squamous epithelium showing four layers of epidermis.
2. Subepithelial tissue infiltrated with inflammatory cells was noted between cholestatoma matrix and bone, and lymphocyte was dominant in it.
3. Inflammatory cells were noted in cholesteatoma matrix, which were increased when subepithelial inflammation was intense.
4. Epithelial hyperplasia and disarray of epidermal keratinocyte in cholesteatoma matrix seemed to depend on degree of subepithelial inflammation.
5. In cholesteatoma, there were active cell divisions in stratum basale, aggregation of tonofilaments and increased keratohyaline granules, which were all suggestive of increased kerationization.
6. Melanocyte was not seen in cholesteatoma matrix as well as in ear canal epidermis< but there were lots of melani(n granules in previous mastoidectomy cavity skin.
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