[Cholesteatoma otitis media and supratubal recess].

OBJECTIVE: To study the significance of supratubal recess and its aeration pathway to epitympanum in the pathogenesis of cholesteatoma otitis media. METHODS: Fifty-two ears of cholesteatoma were selected as study group. Sixteen ears of traumatic facial palsy with pneumatic mastoid, which had no history of chronic otitis media were selected as control group. The status of supratubal recesses of all and their aeration pathways to epitympanum were observed in operations. RESULTS: Sixteen ears from control group clearly presented supratubal recesses. Membrane closure was founded in four of them. The aeration pathways of fifty-two ears (100%) from study group were all completely closed. Comparing with control group, the difference was obviously significant (chi2 = 41.7144, P = 0.000). Among these cases, bony closure was observed in thirty-four ears (65.4%), while membrane closure in eighteen ears (34.6%). Their epitympanum space was very narrow and mastoid was sclerotic or poorly developed. CONCLUSIONS: Blockage of the aeration pathway between supratubal recess and epitympanum was possible one of the origins of negative-pressure status of epitympanum and mastoid, which might lead to the formation of aural cholesteatoma. Anatomy variation of the aeration pathway from supratubal recess to epitympanum might be a pathogenesis factor of cholesteatoma otitis media. It suggested that opening the aeration pathway in tympanoplasty with intact canal wall up technique might be helpful to prevent recurrence of aural cholesteatoma.