Cholesteatomas are bone destructive expansions of keratinizing squamous epithelium in the middle ear and temporal bone. Today, surgery is the only treatment. There are several controversies regarding cholesteatomas, including the definition, the pathogenesis and the surgical method. Intense efforts have been made searching for a comprehension of the cholesteatoma process at a cellular and molecular level. Recurrent infections and inflammation seem to be contributing factors for the cholesteatomas to expand. The innate immunity, essential to keep a healthy middle ear environment and to protect the middle ear from intruding pathogens, is therefore a matter of interest. In this thesis, results are presented from a cohort of cholesteatoma surgeries in Östergötland from a 16-year period. A group of patients also filled in a questionnaire to assess changes in health-related quality of life (HRQoL) after surgery. According to the findings in this thesis, the residual and recurrence frequencies are low, and the hearing and HRQoL are improved in the majority of cases. This thesis also presents an investigation of the innate immunity in ears with acquired cholesteatoma, in comparison with healthy controls. The expression of mRNA of toll-like receptors 2 and 4, participants of the Janus kinase/signal transducer and activator of transcription pathway, and nitric oxide synthases in middle ear mucosa, were investigated with quantitative polymerase chain reaction. An investigation of nitric oxide (NO) in the middle ear, with chemiluminescence measurements, is also presented. A derangement of the innate immune system is seen in ears with cholesteatoma, which supports the idea that the innate immunity participates in the cholesteatoma process, though the underlying mechanisms are still unclear. The suggestion of NO production in the middle ear sheds light on NOs possible participation in the healthy middle ear environment.

Master the challenges of cholesteatoma management with this definitive reference Thieme congratulates Eric E. Smouha on being chosen by New York magazine for its prestigious Best Doctors 2015 list. In this succinctly-organized text, leading specialists have created a comprehensive guide to cholesteatoma and chronic ear disease. Based on the bestselling AAO-HNS course, Cholesteatoma provides in-depth advice for the medical and surgical management of this middle ear entity. Cholesteatoma begins with an introduction of the disease and its general considerations, including preoperative assessment, the role of imaging, and the wet ear. Comprehensive chapters then present the three components of middle ear surgery which are the middle ear, the mastoid, and the meatus and the resultant cavity. The expert authors provide perspective on the controversies in cholesteatoma management like canal wall reconstruction, facial nerve monitoring, the use of endoscopes in chronic ear surgery, and postoperative care. Features: Accompanying online media includes 20 surgical videos performed and narrated by the authors More than 340 vibrant full-color illustrations demonstrate the different disease progressions not shown in any other text Insightful chapters cover recidivism and complications of both the disease and surgery, while O.R. cases illustrate surgical approaches Otolaryngology-head and neck surgeons, residents and fellows will refer to this concise reference on a daily basis for the most up-to-date information on cholesteatomas and other middle ear lesions.

Preface It was a great privilege and honour for me and my deputy chairman Professor Chris Raine to host the 10th International Conference on Cholesteatoma and Ear Surgery (Chole2016) in Edinburgh, Scotland. The Council of the British Society of Otology has helped me tremendously in the preparation of this conference. Over 1000 delegates from 54 countries attended Chole2016 on 5-8 June 2016. The scientific programme included 12 keynote lectures on the basic science of chronic ear diseases; 23 national symposium; 41 round tables; two live temporal bone dissections; 14 video instructional sessions; 18 free paper sessions and poster presentations. I sincerely thank all the faculties who contributed to the scientific programs and also the delegates who provided a lively discussion during the scientific sessions. It was the exchange of knowledge between the speakers and the delegates that makes the conference so worthwhile to me. The aim of Chole2016 was to: Bring basic science on chronic ear diseases to the clinicians. Achieve consensus in definitions, classification and staging of cholesteatoma. The first aim was fulfilled by a scientific programme that focused keynotes sessions on basic sciences. These proved delegates with a fascinating insight into the cellular biology, the role of chronic inflammation, genetic advances, middle ear mechanics/physiology, bacteriology, stem cell research and novel imaging technologies in the context of cholesteatoma. At Chole2016, the joint EAONO/JOS consensus document was presented to the international scientific community for the first time. It led to a lively and productive discussion. A consensus document on classification and staging of cholesteatoma has since been produced. The Proceedings of Chole2016 is available in paper book as well an-PDF (enhanced PDF with links) and EPUB (optimized for tablets). The electronic versions are freely downloadable for all. If you want a copy (paper book) Kugler Publications can also provide POD (Publishing on Demand) copies for a reasonable price. Finally, I am very much looking forward to seeing all of you at the 11th Conference in Shanghai in 2020! Matthew Yung

Proceedings of the 9th International Conference on Cholesteatoma and Ear Surgery. June 3-7, 2012, Nagasaki, Japan. Many color illustrations and tables. A4 (8.3x11.7 in).

Acquired aural cholesteatoma poses a unique procedural dilemma with regard to pathogenetic research and theory building. Because cholesteatoma spontane ously occurs only in the poorly pneumatized human ear, its pathogenesis is specific to humans. Nonetheless, because of the ethical questions surrounding human experimentation, pathogenetic study has almost exclusively involved nonhuman subjects. Indeed, attempts have failed in almost all animal expe riments except with the gerbil, and even here experimental designs have been improbable compared with human cholesteatoma. Cholesteatoma in the gerbil is useful, therefore, only for the study of pathology and not for human pathogenesis. I hold that the pathogenesis of cholesteatoma will be understood by studying the cholesteatomatous ear, that is, the malpneumatized ear of the human. The anatomical difference between the normal and malpneumatized ear is a probable cause of cholesteatoma. This difference may be found clinically in facial nerve decompression and cholesteatoma surgery, as, for example, facial nerve palsy occurs usually in the normal, well-pneumatized ear. Of course, conventional animal experimentation will not confirm this clinical difference since there is no ideal animal model for the poorly pneumatized human ear. Present surgical techniques for cholesteatoma vary greatly according to indi vidual otosurgeon's opinion. The most extreme difference of opinion is focused on whether to remove the external ear canal wall. Normally, the best option would be not to remove the canal wall if cholesteatoma recurrence can be prevented. Simply put, recurrence of cholesteatoma comes about when its cause has not been removed during primary surgery.

The key reference dedicated to surgery for cholesteatoma... The cholesteatoma, strictly speaking a cyst and not a cancer, nevertheless shows expansive and destructive growth patterns that may give rise to serious symptoms and consequences, including fatality, not unlike those seen for malignant neoplasms. The great challenge of therapy is to eradicate the pathologic growth while preserving hearing and other critical functions of the middle ear and petrous bone, respecting the proximity of vital neural and vascular structures, and the intricate three-dimensional relationships involved. Mario Sanna's Microsurgical Management of Middle Ear and Petrous Bone Cholesteatoma is the ultimate illustrated guide to complete management of the cholesteatoma, including assessment of the full expansion and degree of destruction caused by the growths, and short- and long-term follow-up to assess and treat for recurrence. Key Features Brilliantly illustrated with diagnostic images from otoscopy and radiology, both normal and pathological Step-by-step description of approaches and techniques for the procedures Special coverage of petrous bone cholesteatoma, which is less frequent than other forms but more difficult to diagnose and treat, with introduction and description of a new function-sparing procedure, the subtotal petrosectomy Microsurgical Management of Middle Ear and Petrous Bone Cholesteatoma extends Mario Sanna's passionate dedication to excellence in otologic teaching and training into this highly complex surgical area. Practitioners, residents, and fellows will find it indispensable.