A child is found to have a cholesteatoma at birth in the middle ear with an intact tympanic membrane. The most likely pathogenesis of this cholesteatoma is:
- A Invagination of posterosuperior tympanic membrane
- B Congenital epidermal cell rest failing to involute ✓
- C Squamous metaplasia of middle ear mucosa
- D Migration of squamous epithelium through a perforation
Correct answer: B. Congenital epidermal cell rest failing to involute
Explanation
Congenital cholesteatoma arises from epithelial cell rests (Jacobson's theory) — embryonic ectodermal remnants that persist in the middle ear, usually anterosuperior to the handle of malleus. The tympanic membrane is intact, there is no history of ear disease or surgery, and it presents as a white, pearly mass behind an intact drum, distinguishing it from acquired cholesteatoma.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.