A secondary acquired cholesteatoma is believed to arise via which mechanism?
- A Ingrowth of squamous epithelium through a marginal perforation, particularly in the posterosuperior quadrant ✓
- B Retraction pocket formation in the pars flaccida due to chronic eustachian tube dysfunction
- C Metaplasia of the middle ear mucosa
- D Congenital inclusion of ectodermal rests behind an intact pars tensa
Correct answer: A. Ingrowth of squamous epithelium through a marginal perforation, particularly in the posterosuperior quadrant
Explanation
Secondary acquired cholesteatoma arises from migration of squamous epithelium through a marginal perforation (defect at the annulus), typically in the posterosuperior quadrant — this is the classic pathway for secondary acquired disease. Primary acquired cholesteatoma (the more common type) arises from pars flaccida retraction pockets (Prussak's space) due to chronic eustachian tube dysfunction (option B). Metaplasia is a less supported theory. Congenital cholesteatoma (option D) is an entirely separate entity occurring behind an intact eardrum in children.
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.