Role of cell mediated immune response in pathogenesis of cholesteatoma

The role of cell mediated immune [CMI] response in the initiation of aural cholesteatoma was studied. Migration inhibition test [MI1] was done for 20 patients with cholesteatoma, 10 with tubotympanic chronic otitis media and 10 normal subjects, using cholesteatoma matrix as an antigen. All cholesteatoma patients had significant positive leucocyte migration inhibition response compared to the other 2 groups [P<0.05], indicating a specific antigenicity and confirming the presence of CMI response in such patients. The level of leucocyte migration inhibition factor [LMIF] was significantly correlated with extension of the disease. In the mastoid disease, LMIF was higher than that in the localized attic one [P<0.05], indicating a relationship between the degree of immunological status and extent of cholesteatoma. Other parameters such as age, sex duration of the disease, recurrence or complications did not correlate with LMIF values. The bone resorption in cholesteatoma has been explained by the occurrence of CMI response, against cholesteatoma antigen, resulting in the release of many chemical mediators that might have a lytic activity. Further studies are recommended

Significance of Langerhans' cells in middle ear cholesteatoma

Recent advances in immunology have opened a new approach to investigating the etiology and pathogenesis of aural cholesteatoma by the immunohistochemical technique. Immunohistochemical and submicroscopic analysis of human cholesteatoma matrices revealed the presence of Langerhans' cells. Several reports have suggested that Langerhans' cells in cholesteatoma are significant, and that the pathogenesis of this disease including bone resorption could be explained as a cell-mediated immune response, but this is still controversial. In this study, Langerhans' cells in cholesteatoma were quantitated and compared with those in postauricular skin and in skin of the open mastoidectomized cavity. The results did not support the hypothesis that Langerhans' cells have a primary role in the development of aural cholesteatoma.