Epithelial migration

Ear, Nose & Throat Journal, August, 2004 by Christian Deguine, Jack L. Pulec

We evaluated a 30-year-old man who had chronic bilateral otitis. Otoscopic examination of the right ear revealed an old posterior perforation, through which the oval window niche could not be seen (figure). The patient's average air-bone gap was 20 dB, which suggested that the ossicular chain was intact and mobile. The anterior half of the drum was translucent. A layer of epithelial tissue appeared to insinuate itself around the handle of the malleus, and it extended to the medial surface of the anterior drum remnant. Superiorly, the tissue disappeared under the posterior tympanomalleal ligament. Interiorly, the epithelium appeared to invaginate toward the posterior recess of the middle ear space. The need for surgery was clear; otherwise, eventual evolution toward a cholesteatoma was inevitable.

[FIGURE OMITTED]

Epithelial migration is a classic but rare pathogenic pathway in the formation of cholesteatomas. It may be predisposed by the presence of tympanoselerotic plaques, although this did not occur in our patient. Surgeons who encounter such a case must perform a very meticulous dissection of the epithelial tissue and insist on annual follow-up for several years to avoid the risk of an iatrogenic cholesteatoma.

From Gap, France (Dr. Deguine) and the Pulec Ear Clinic, Los Angeles (Dr. Pulec).

Christian Deguine, MD; Jack L. Pulec, MD ([dagger])

([dagger]) The late Dr. Pulec was editor-in-chief of EAR NOSE & THROAT JOURNAL from 1992 through 2003.