Otologists are familiar with the important rôle played by cholesteatoma as a complication in suppuration of the middle ear. Examination of the pus with the naked eye usually gives a sufficient basis for suspecting cholesteatoma. In addition, the various-sized masses revealed by irrigation with the attic cannula strengthen the diagnosis. The detection of typical cholesterol crystals under the microscope gives positive evidence of cholesteatoma. Unfortunately, these crystals are lacking in many cases. Their absence, therefore, does not exclude the possibility of cholesteatoma. Recently, efforts have been made to determine the presence of cholesteatoma by roentgen examination, but results in general are uncertain, although occasionally the pictures show the size and location of the mass.
Johannes Müller first called attention to the presence of cholesterol in the tumors made up of desquamating epithelium in chronic suppurative otitis media, and he therefore named these masses cholesteatoma. Virchow opposed this nomenclature. In his
REJTÖ A. CHOLESTEATOMASOME NEW PRINCIPLES IN ITS TREATMENT, INCLUDING THE TEST FOR ITS CHEMICAL DEMONSTRATION. Arch Otolaryngol. 1931;13(5):709–713. doi:10.1001/archotol.1931.03660020073005