CHOLESTEATOMA of the middle ear and mastoid process has been the subject of much study and speculation since it was first described by Müller,1 in 1838, and since Virchow2 gave the first explanation of its origin, in 1855. It is the purpose of this paper to present evidence of cholesteatoma formation following the use of skin grafts in the cavity resulting from radical mastoidectomy, to correlate these findings with the theories of the histogenesis of cholesteatoma, and to question strongly the procedure of skin grafting after a radical mastoidectomy.
Prior to 1946 I had performed 268 radical mastoidectomies. The technique used in all these cases was the classic postauricular radical mastoidectomy procedure. The operation was carried out by means of the gouge, chisel, curette, and rongeur. The mastoid cavity and the epitympanic and hypotympanic spaces were rather carefully cleaned out. The tympanic space was cleansed of the grosser