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Morphologic Development of Experimental Cholesteatoma

Morphologic Development of Experimental Cholesteatoma Abstract • Using light microscopy, we studied the morphologic events of cholesteatoma progression 8 months after ligation of the ear canal in 14 Mongolian gerbils. Although we observed a wide range of progression, four stages of morphologic development could be clearly distinguished among the 28 specimens: stage I, an orthokeratotic plug in the ear canal without tympanic membrane involvement; stage II, partial retraction of the tympanic membrane; stage III, the interface between cholesteatoma encapsulated within the tympanic membrane and mucosal membranes covering the promontorial wall of the middle-ear cavity was characterized by a buildup of granulation tissue with prominent macrophage infiltration; and stage IV, bone destruction. Chronic inflammation was observed in some but not all stage II to IV cases. Our results indicate that hyperkeratosis is a primary event in cholesteatoma development, that the development of the granulation tissue with activated macrophages may be responsible for the bone destruction, and that acute or chronic inflammation is not a prerequisite for the development of cholesteatoma or the bone resorptive process. (Arch Otolaryngol Head Neck Surg. 1993;119:272-275) References 1. Goodhill V. Should cholesteatoma be considered a dangerous disease? In: Sade J. Cholesteatoma and Mastoid Surgery: Proceedings of the Second International Conference . Amsterdam, the Netherlands: Kugler Publications; 1982;75-76. 2. Abramson M, Moriyama H, Huang C. Pathogenic factors in bone resorption in cholesteatoma . Acta Otolaryngol (Stockh) . 1984;97:437-442.Crossref 3. Bretlau P, Hjort Sörensen C, Balslev Jörgensen M, Dabelsteen E, Holmstrup P. Bone resorption in cholesteatomas: an experimental study . Acta Otolaryngol (Stockh) . 1984;( (suppl 414) ):178-185. 4. Kahn A, Stewart C, Teitelbaum S. Contact-mediated bone resorption by human moncytes in vitro . Science . 1978;199:988-989.Crossref 5. Kaneko Y, Yuasa R, Ise I, et al. Bone destruction due to the rupture of a cholesteatoma sac: a pathogenesis of bone destruction in aural cholesteatoma . Laryngoscope . 1980;90:1865-1071.Crossref 6. Mundy G, Altman A, Gondek M, Bandelin J. Direct resorption of bone by human monocytes . Science . 1977;196:1109-1110.Crossref 7. Chole RA. Cellular and subcellular events of bone resorption in human and experimental cholesteatoma: the role of osteoclasts . Laryngoscope . 1984;94:76-95.Crossref 8. Åberg B, Edström S, Johannesson A, Larkö O. Evaluation of epidermal hyperproliferation in patients with cholesteatoma . Am J Otol. 1991;12:93-96.Crossref 9. Aberg B, Bagger-Sjöbäck D, Edström S, Heyden G, Jacobsson M, Kindblom L-G. A comparative study of enzyme histochemical features in the gerbilline and human cholesteatoma . Acta Otolaryngol (Stockh) . 1990;109: 130-136.Crossref 10. Thomsen J. Bone resorption in chronic otitis media: the role of cholesteatoma, a must or an adjunct? Clin Otolaryngol. 1981;6:179-186.Crossref 11. Breinlich T, Giebel W. Histochemical studies of cholesteatoma . Arch Otorhinolaryngol. 1984;240:95-101.Crossref 12. Abramson M, Huang C. Localization of collagenase in human middle ear cholesteatoma . Laryngoscope . 1977;87:771-791.Crossref 13. Adachi K, Chole R, Yee J. Indomethacin inhibition of middle ear bone resorption . Arch Otolaryngol Head Neck Surg. 1991;117:267-269.Crossref 14. Yan S-D, Huang C-C. The role of tumor necrosis factor-alpha in bone resorption of cholesteatoma . Am J Otolaryngol. 1991;12:83-89.Crossref 15. Chole R, McGinn M, Tinling S. Pressure induced bone resorption in the middle ear . Ann Otol Rhinol Laryngol. 1985;94:165-170. 16. Åberg B, Westin T, Tjellström A, Edström S. Clinical characteristics of cholesteatoma disease . Am J Otolaryngol. 1991;12:254-258.Crossref 17. McGinn M, Chole R, Henry K. Cholesteatoma: experimental induction in the Mongolian gerbil, Meriones unguiculatus . Acta Otolaryngol (Stockh) . 1982;93:61-67.Crossref 18. McGinn M, Chole R, Henry K. Cholesteatoma induction: consequences of external auditory canal ligation in gerbils, cats, hamsters, guinea pigs, mice and rats . Acta Otolaryngol (Stockh) . 1984;97:297-304.Crossref 19. Chole R, Henry K, McGinn M. Cholesteatoma: spontaneous occurrence in the Mongolian gerbil, Meriones unguiculatus . Am J Otol. 1981;2: 204-210. 20. Gantz B, Maynard J, Busted R, Huang C, Abramson M. Bone resorption in chronic otitis media . Ann Otol Rhinol Laryngol. 1979;88:693-700. 21. Åberg B, Jontell M, Edström S. Analysis of class II antigen expressing cells in cholesteatoma cells . Acta Otolaryngol (Stockh) . 1988;106:186-191.Crossref 22. Bagger-Sjöbeck D, Haverling M, Hjerpe A, Mendel L. The mineral content of the middle ear ossicles . Am J Otol. 1987;8:8-13. 23. Tanaka K, Terayama Y, Hirai T. Electron microscope study of bone lesion in cholesteatom otitis . Arch Otorhinolaryngol. 1980;226:85-92.Crossref 24. Thomsen J, Tos M, Nielsen M, Balslev Jörgensen M. Bone destruction in inflammatory diseases of the ear . In: Sade J. Cholesteatoma and Mastoid Surgery: Proceedings of the Second International Conference . Amsterdam, the Netherlands: Kugler Publications; 1982:397-411. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1993 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.1993.01880150020003
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Abstract

Abstract • Using light microscopy, we studied the morphologic events of cholesteatoma progression 8 months after ligation of the ear canal in 14 Mongolian gerbils. Although we observed a wide range of progression, four stages of morphologic development could be clearly distinguished among the 28 specimens: stage I, an orthokeratotic plug in the ear canal without tympanic membrane involvement; stage II, partial retraction of the tympanic membrane; stage III, the interface between cholesteatoma encapsulated within the tympanic membrane and mucosal membranes covering the promontorial wall of the middle-ear cavity was characterized by a buildup of granulation tissue with prominent macrophage infiltration; and stage IV, bone destruction. Chronic inflammation was observed in some but not all stage II to IV cases. Our results indicate that hyperkeratosis is a primary event in cholesteatoma development, that the development of the granulation tissue with activated macrophages may be responsible for the bone destruction, and that acute or chronic inflammation is not a prerequisite for the development of cholesteatoma or the bone resorptive process. (Arch Otolaryngol Head Neck Surg. 1993;119:272-275) References 1. Goodhill V. Should cholesteatoma be considered a dangerous disease? In: Sade J. Cholesteatoma and Mastoid Surgery: Proceedings of the Second International Conference . Amsterdam, the Netherlands: Kugler Publications; 1982;75-76. 2. Abramson M, Moriyama H, Huang C. Pathogenic factors in bone resorption in cholesteatoma . Acta Otolaryngol (Stockh) . 1984;97:437-442.Crossref 3. Bretlau P, Hjort Sörensen C, Balslev Jörgensen M, Dabelsteen E, Holmstrup P. Bone resorption in cholesteatomas: an experimental study . Acta Otolaryngol (Stockh) . 1984;( (suppl 414) ):178-185. 4. Kahn A, Stewart C, Teitelbaum S. Contact-mediated bone resorption by human moncytes in vitro . Science . 1978;199:988-989.Crossref 5. Kaneko Y, Yuasa R, Ise I, et al. Bone destruction due to the rupture of a cholesteatoma sac: a pathogenesis of bone destruction in aural cholesteatoma . Laryngoscope . 1980;90:1865-1071.Crossref 6. Mundy G, Altman A, Gondek M, Bandelin J. Direct resorption of bone by human monocytes . Science . 1977;196:1109-1110.Crossref 7. Chole RA. Cellular and subcellular events of bone resorption in human and experimental cholesteatoma: the role of osteoclasts . Laryngoscope . 1984;94:76-95.Crossref 8. Åberg B, Edström S, Johannesson A, Larkö O. Evaluation of epidermal hyperproliferation in patients with cholesteatoma . Am J Otol. 1991;12:93-96.Crossref 9. Aberg B, Bagger-Sjöbäck D, Edström S, Heyden G, Jacobsson M, Kindblom L-G. A comparative study of enzyme histochemical features in the gerbilline and human cholesteatoma . Acta Otolaryngol (Stockh) . 1990;109: 130-136.Crossref 10. Thomsen J. Bone resorption in chronic otitis media: the role of cholesteatoma, a must or an adjunct? Clin Otolaryngol. 1981;6:179-186.Crossref 11. Breinlich T, Giebel W. Histochemical studies of cholesteatoma . Arch Otorhinolaryngol. 1984;240:95-101.Crossref 12. Abramson M, Huang C. Localization of collagenase in human middle ear cholesteatoma . Laryngoscope . 1977;87:771-791.Crossref 13. Adachi K, Chole R, Yee J. Indomethacin inhibition of middle ear bone resorption . Arch Otolaryngol Head Neck Surg. 1991;117:267-269.Crossref 14. Yan S-D, Huang C-C. The role of tumor necrosis factor-alpha in bone resorption of cholesteatoma . Am J Otolaryngol. 1991;12:83-89.Crossref 15. Chole R, McGinn M, Tinling S. Pressure induced bone resorption in the middle ear . Ann Otol Rhinol Laryngol. 1985;94:165-170. 16. Åberg B, Westin T, Tjellström A, Edström S. Clinical characteristics of cholesteatoma disease . Am J Otolaryngol. 1991;12:254-258.Crossref 17. McGinn M, Chole R, Henry K. Cholesteatoma: experimental induction in the Mongolian gerbil, Meriones unguiculatus . Acta Otolaryngol (Stockh) . 1982;93:61-67.Crossref 18. McGinn M, Chole R, Henry K. Cholesteatoma induction: consequences of external auditory canal ligation in gerbils, cats, hamsters, guinea pigs, mice and rats . Acta Otolaryngol (Stockh) . 1984;97:297-304.Crossref 19. Chole R, Henry K, McGinn M. Cholesteatoma: spontaneous occurrence in the Mongolian gerbil, Meriones unguiculatus . Am J Otol. 1981;2: 204-210. 20. Gantz B, Maynard J, Busted R, Huang C, Abramson M. Bone resorption in chronic otitis media . Ann Otol Rhinol Laryngol. 1979;88:693-700. 21. Åberg B, Jontell M, Edström S. Analysis of class II antigen expressing cells in cholesteatoma cells . Acta Otolaryngol (Stockh) . 1988;106:186-191.Crossref 22. Bagger-Sjöbeck D, Haverling M, Hjerpe A, Mendel L. The mineral content of the middle ear ossicles . Am J Otol. 1987;8:8-13. 23. Tanaka K, Terayama Y, Hirai T. Electron microscope study of bone lesion in cholesteatom otitis . Arch Otorhinolaryngol. 1980;226:85-92.Crossref 24. Thomsen J, Tos M, Nielsen M, Balslev Jörgensen M. Bone destruction in inflammatory diseases of the ear . In: Sade J. Cholesteatoma and Mastoid Surgery: Proceedings of the Second International Conference . Amsterdam, the Netherlands: Kugler Publications; 1982:397-411.

Journal

Archives of Otolaryngology - Head & Neck SurgeryAmerican Medical Association

Published: Mar 1, 1993

References