Knowledge about cholesteatoma, from the first description to the modern histopathology

Abstract

Objective: The aim of this study was to understand the historical development of the knowledge of cholesteatoma.

Materials and methods: Review of the literature from 1683 to 1999 concerning the date-related knowledge of cholesteatoma.

Results: In 1683, Duverney first described a temporal bone tumor probably corresponding to a cholesteatoma. Until 1838, when Müller coined the term cholesteatoma, nothing new about this condition appeared in medical publications. After 1838, three main theories about the pathogenesis of cholesteatoma were published. Virchow, in 1855, considered cholesteatoma to be a tumor arising from the metaplasia of mesenchymal cells to epidermal cells, growing then as tumoral cells. Gruber, Wendt, and von Troeltsch, in 1868, considered cholesteatoma to be the result of a metaplasia not of bone cells but of tympanic mucosa cells into a malpighian epithelium. Politzer, in 1869, assumed that cholesteatoma was a glandular neoplasm of middle ear mucosa. Bezold and Habermann, in 1889, considered cholesteatoma to be the result of migration of the external ear canal epidermis into the tympanic cavity via a marginal perforation after acute or chronic otitis. It took 40 years of discussions about these three theories to finally confirm that Habermann and Bezold were correct.

Conclusion: The knowledge of cholesteatoma has evolved with other medical branches. As otologists began to monitor their patients in vivo, not limiting their observations to temporal bone dissections, the genesis of cholesteatoma became well understood. Today, with immunology and new histopathologic techniques, it is anticipated that we will learn much more about cholesteatoma.