There is in most instances of recognized clinical cholesteatoma a long preceding period of unobserved cellular, membrane, and tissue changes which take place to a large extent beyond the range of clinical observation. Histological studies on the early genesis of cholesteatoma are limited, and for this reason interpretation of such findings and theoretical deductions are somewhat varied. In view of this, it seems worthwhile to add to the literature my own observations on the subject over a period of approximately 30 years and, in particular, to report an instance of attic cholesteatoma which at the time of surgery had no epithelial continuity with the external meatus.
The various theories of attic and middle ear cholesteatoma genesis have recently been discussed by Fernandez1 and will not be reviewed in detail here. The metaplasia concept of cholesteatoma origin is considered by both Fernandez and Harris2 as lacking clinical or experimental