Clinical and etiopathogenetic aspects of acquired middle ear cholesteatoma

Objective. To conduct a clinical, instrumental and microbiological examination of patients with middle ear cholesteatoma and characterize the main ultrastructural markers of the proliferative-dystrophic process in cholesteatoma biopsies.
Materials and methods. The study included data from 16 patients who were examined and treated at the Republican Scientific and Practical Center of Otorhinolaryngology. All patients underwent a comprehensive clinical and instrumental examination, including bacteriological examination of the discharge of the external auditory canal and the tympanic cavity for opportunistic microflora. In order to indicate the DNA of various intracellular pathogens (Ch. trachomatis, M. genitalium, herpes simplex viruses types 1 and 2, papillomaviruses, etc.), biopsy material from cholesteatoma was analyzed.
Results. According to the results of a clinical and instrumental examination, the following signs were found: hearing loss (81.25 %), periodic suppuration (100 %), noise in the ear (31.25 %), dizziness (37.5 %). In 100 % cases with computer tomography a pathological soft-tissue process in middle ear cavity was detected. Microbiological analysis established the following species: S. aureus, S. epidermidis, P. aeruginosa. The results of the analysis for the presence of pathogens in the cholesteatoma tissue allowed us to state the presence in some cases of bacterial agents, belonging to the Chlamydiaceae and Mycoplasmataceae families. The molecular biological analysis did not reveal the DNA of intracellular pathogens.
Conclusion. Ultrastructural analysis made it possible to systematize the pathomorphosis of the main extraand intracellular compartments of cholesteatoma and to assess collagen destruction in the stromal-mesenchymal layer. For the first time, evidence is presented of the presence of intracellular bacterial agents belonging to the Chlamydiaceae and Mycoplasmataceae in the epithelial cells of cholesteatoma. The obtained results indicate the etiological significance and involvement of opportunistic microorganisms and intracellular pathogens in the multifaceted damaging effects on middle ear cells

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