Cholesteatoma Attic Retraction

Eustachian tube theory.

Cholesteatoma attic retraction.

Primary acquired cholesteatoma or retraction cholesteatoma this form of cholesteatoma is due to a ventilation malfunction in the middle ear often caused by insufficient tube permeability. A retraction pocket seen in the attic or posterosuperior quadrant of a tympanic membrane is the hallmark of an acquired cholesteatoma. Granulation tissue may arise from the mucosa adjacent to the cholesteatoma figure 6c. Skin material often accumulates in this pocket and becomes infected causing drainage and potential severe complications.

Often there is an accumulation of squamous debris within the pocket figure 6a b. Such causes can include for example poor eustachian tube function which results in retraction of the ear drum and failure of the normal outward migration of skin. The tube is a conduit between the middle ear and the nasopharyngeal space. A recurrent cholesteatoma is a new cholesteatoma that develops when the underlying causes of the initial cholesteatoma are still present.

Invagination of the tympanic membrane of the attic to form retraction pockets to be filled with desquamated epithelium and keratin to form cholesteatoma. There is an attic erosion partially exposing posterior half of drum deeply retracted and this pocket is full of keratin flakes.