Retraction pocket cholesteatoma

The vast majority of cholesteatomas seen clinically are the primary acquired or retraction pocket type. Negative pressure of the middle ear space is a nidus for retraction pocket formation and subsequent cholesteatoma development. The causes of negative pressure of the middle ear are linked to longstanding eustachian tube dysfunction and the lack of a pneumatized mastoid. Recent studies have demonstrated the use of slow motion video to elucidate the causes of eustachian tube dysfunction in patients. Studies have also linked the degree of mastoid pneumatization with negative ear pressure. The pathogenesis of retraction pocket cholesteatoma formation is controversial. The transition from retraction pocket to actual cholesteatoma formation may be explained by a combination of the invagination and proliferative theories.