Go to top a skin cyst caused by a long standing retraction pocket of the eardrum into the middle ear.
Attic retraction pocket cholesteatoma.
The cyst slowly erodes bone and can cause facial paralysis hearing loss dizziness and if left untreated can slowly erode into the brain cavity.
This retraction pocket becomes later filled with desquamated epithelial debris which forms a nidus for the infection to occur later.
There has been significant bone erosion of the ear canal wall above the eardrum.
Often there is an accumulation of squamous debris within the pocket figure 6a b.
Although the pathogenesis of acquired cholesteatoma remains controversial the most widely accepted theory is the retraction pocket theory which states that dysfunction of the eustachian tube leads to the buildup of negative pressure in the middle ear such that a segment of the tympanic membrane most commonly the pars flaccida is drawn into the middle ear and becomes sequestered followed by accumulation of the trapped keratin.
Stratified squamous epithelium may also be present in the middle ear as other clinical or pathological entities such as metaplastic islands of the mucosa in chronic ears with central perforations.
Skin material often accumulates in this pocket and becomes infected causing drainage and potential severe complications.
This is the most common and widely considered as the main reason for cholesteatoma.
Pathophysiology toss theory of invagination.
Invagination of the tympanic membrane of the attic to form retraction pockets to be filled with desquamated epithelium and keratin to form cholesteatoma.
This is a serious condition.
Eds aesculapius publishing company birmingham alabama pp.
This is differentiated from an infected retraction pocket of the pars tensa or a retraction pocket cholesteatoma.
A retraction pocket seen in the attic or posterosuperior quadrant of a tympanic membrane is the hallmark of an acquired cholesteatoma.
Persistent negative pressure in the attic region causes invagination of pars flaccida causing a retraction pocket.
It is hypothesized that blockade of the tympanic isthmus causes isolation of the attic and the adjacent middle ear spaces and that subsequent building up of the negative pressure in these spaces results in retraction of the pars flaccida leading to formation of attic retraction pockets and cholesteatomas.
To examine this theory computerized tomographic ct findings of these conditions were evaluated in a series of 53 ears with retractions of the pars flaccida attic retractions.
Retraction pockets a retraction pocket is an invagination of the tympanic membrane.
Mccabe b sadé j and abramson m.
In cholesteatoma first international conference.
1 attic retraction pocket cholesteatoma is clearly visualized white arrow.
Eustachian tube theory.
Common organisms to infect this keratin debris are psuedomonas e.
An attic cholesteatoma is defined as an epidermoid cyst found in the attic.
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.
