title: Acquired cholesteatoma: summary of the cascade of molecular events.
abstract: BACKGROUND
  Cholesteatoma is considered a benign, gradually expanding and destructive epithelial lesion of the temporal bone. The pathogenesis of different classifications of cholesteatoma is marked by similar underlying cellular and molecular processes. Stepwise explanations of the histopathogenesis have been described previously. The current paper focuses on expounding the molecular events of cholesteatoma.
  
  
  RESULTS
  Cholesteatoma pathogenesis encompasses a complex network of signalling pathways during: epidermal hyperplasia, perimatrix-matrix interactions and mucosal disease. This paper presents a review of the molecular events driven by inflammatory mediators and enzymes during: cholesteatoma growth (cell proliferation and apoptosis); maintenance and deterioration (angiogenesis and hypoxia, oxidative stress and toxicity); and complications (bone erosion and hearing loss). The cascade of molecular events applicable to atelectasis and cholesteatoma that coexist with chronic otitis media and bone erosion as sequelae is summarised.
  
  
  CONCLUSIONS
  The role of lipids in this disease is relatively unexplored, but there is evidence in support of fatty acid role-players that needs confirmation. Future directions in lipid research to delineate molecular mechanisms are proposed.
authors: Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa. gnanll.md@ufs.ac.za
authors: L
authors: L
authors: Louw
mesh_terms: D017209:Apoptosis; D049109:Cell Proliferation; D018424:Cholesteatoma, Middle Ear / Q000209:etiology* / Q000378:metabolism; D004432:Ear, Middle / Q000378:metabolism; D005227:Fatty Acids / Q000378:metabolism; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000378:metabolism; D050356:Lipid Metabolism
chemical_list: D005227:Fatty Acids