title: Mycological study on cholesteatoma keratin obtained during primary mastoid surgery.
abstract: OBJECTIVE
  Established middle-ear cleft cholesteatoma is associated with keratinous debris, which is likely to be an ideal medium for saprophytic fungal colonisation. This prospective case study aimed to explore the incidence and nature of fungal elements in cholesteatoma keratin samples obtained during primary mastoid surgery.
  
  
  METHODS
  All cases of middle-ear cleft cholesteatoma treated with primary mastoid surgery at the El-Sahel Teaching Hospital over a seven-month period were included. Keratinous debris obtained from the mastoid antrum was subjected to mycological analysis at the Department of Medical Microbiology and Immunology, Faculty of Medicine, Cairo University. A literature search was performed to determine the clinical and pathological relevance of fungal colonisation in cholesteatoma.
  
  
  RESULTS
  Eighteen patients underwent primary mastoid surgery for cholesteatoma (nineteen ears in total) in a seven-month period starting 30 March 2013. Patients included 13 males and 5 females, with an age range of 9 to 45 years (mean 23 years). Fungal cultures were obtained from 17 keratin samples (89 per cent). Of these, five fungal isolates belonged to the dermatophyte group (21 per cent).
  
  
  CONCLUSIONS
  Fungal colonisation in middle-ear cleft cholesteatoma probably plays a significant role in disease progression. Moreover, saprophytic fungal colonisation in cholesteatoma keratin may be responsible for the fetor commonly associated with the ear discharge.
authors.affiliation: Department of Otolaryngology,El-Sahel Teaching Hospital,Cairo,Egypt.
authors.forename: K G
authors.initials: KG
authors.lastname: Effat
authors.affiliation: Department of Medical Microbiology and Immunology,Faculty of Medicine,Cairo University,Cairo,Egypt.
authors.forename: N M
authors.initials: NM
authors.lastname: Madany
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D018424:Cholesteatoma, Middle Ear / Q000382:microbiology*; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005658:Fungi / Q000302:isolation & purification*; D006097:Granulation Tissue / Q000382:microbiology; D006801:Humans; D007633:Keratins / Q000032:analysis; D008297:Male; D008416:Mastoid / Q000601:surgery*; D008875:Middle Aged; D010033:Otitis Media / Q000601:surgery; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D007633:Keratins