The widespread use of chemotherapy and antibiotics has modified considerably the general picture of middle-ear cholesteatoma.
Cholesteatoma which originates by immigration of epidermis through a marginal or total perforation of pars tensa after necrotizing otitis media, as substantiated by Habermann1 and Polvogt,2 has been greatly reduced, while the incidence of attic cholesteatoma has shown no definite decrease.
The origin of attic cholesteatoma has not been agreed upon in spite of extensive clinical and histopathologic studies. The evidence presented by various sources supports the theory of several origins. No single explanation has been adequate to account for all types which have been examined histologically or observed clinically.
The current theories may be summarized as follows:
Epidermoid theory. This theory assumes the inclusion during embryonic life of fetal epidermal cells. McKenzie3 argued that all middle-ear cholesteatomas are primarily epidermoids of the same nature as the intracranial cholesteatoma of Johannes
FERNÁNDEZ C, LINDSAY JR, MOSKOWITZ M. Some Observations on the Pathogenesis of Middle-Ear Cholesteatoma. AMA Arch Otolaryngol. 1959;69(5):537–546. doi:10.1001/archotol.1959.00730030549003