A retraction pocket seen in the attic or posterosuperior quadrant of a tympanic membrane is the hallmark of an acquired cholesteatoma.
Attic retraction pocket cholesteatoma.
Common organisms to infect this keratin debris are psuedomonas e.
Granulation tissue may arise from the mucosa adjacent to the cholesteatoma figure 6c.
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.
Go to top a skin cyst caused by a long standing retraction pocket of the eardrum into the middle ear.
This is differentiated from an infected retraction pocket of the pars tensa or a retraction pocket cholesteatoma.
This is the most common and widely considered as the main reason for cholesteatoma.
A recurrent cholesteatoma is a new cholesteatoma that develops when the underlying causes of the initial cholesteatoma are still present.
Skin material often accumulates in this pocket and becomes infected causing drainage and potential severe complications.
Retraction pockets a retraction pocket is an invagination of the tympanic membrane.
Eustachian tube theory.
This is a serious condition.
An attic cholesteatoma is defined as an epidermoid cyst found in the attic.
1 attic retraction pocket cholesteatoma is clearly visualized white arrow.
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.
This retraction pocket becomes later filled with desquamated epithelial debris which forms a nidus for the infection to occur later.
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The cyst slowly erodes bone and can cause facial paralysis hearing loss dizziness and if left untreated can slowly erode into the brain cavity.
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.
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.
Pathophysiology toss theory of invagination.
1977 the significance of the retraction pocket in the treatment of cholesteatoma.
Persistent negative pressure in the attic region causes invagination of pars flaccida causing a retraction pocket.
Mccabe b sadé j and abramson m.
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.
