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.

Cholesteatoma attic retraction.

1 attic retraction pocket cholesteatoma is clearly visualized white arrow. A recurrent cholesteatoma is a new cholesteatoma that develops when the underlying causes of the initial cholesteatoma are still present. A retraction pocket seen in the attic or posterosuperior quadrant of a tympanic membrane is the hallmark of an acquired cholesteatoma. 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. Often there is an accumulation of squamous debris within the pocket figure 6a b. This is the most common and widely considered as the main reason for cholesteatoma. The tube is a conduit between the middle ear and the nasopharyngeal space.

Skin material often accumulates in this pocket and becomes infected causing drainage and potential severe complications. Granulation tissue may arise from the mucosa adjacent to the cholesteatoma figure 6c.