THE PURPOSE of this paper is to present the conflicting views concerning the origin of aural cholesteatoma and to direct attention to the premise that this lesion may have a single cause. It seems plausible to attempt to combine the various types of this lesion under one grouping. Why have different explanations for a pathological process which may clinically manifest itself in various forms? However, it is essential to explain how a tumor composed of stratified epithelial cell elements can arise in a cavity lined by columnar epithelium.
Cholesteatoma, incidentally a poor term, literally means a tumor of bile and fat. It was first used by Müller in 1838 when he discovered the laminated appearance of the cholesterin-containing cyst. Several years previously, the lesion was originally described by Cruveilheir,1 who called it a "pearl tumor." Virchow in 1855 felt that these growths were congenital in nature and due to