International Journal of Otorhinolaryngology and Head and Neck Surgery | June 2021 | Vol 7 | Issue 6 Page 933 International Journal of Otorhinolaryngology and Head and Neck Surgery Rajashekhar RP et al. Int J Otorhinolaryngol Head Neck Surg. 2021 Jun;7(6):933-937 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 Original Research Article Clinical study of active squamosal chronic otitis media Rashmi P. Rajashekhar, Rohit Anand*, Gundappa D. Mahajan, K. Gowtham, Parul Rathi INTRODUCTION Cholesteatoma term was coined by Johannes Muller in 1838. Cholesteatomas are the last stage of squamous epithelial retraction comprising either the pars tensa or flaccida that are not self-cleansing, which retain epithelial debris and elicit a secondary, inflammatory reaction. 1 Active squamosal epithelial disease is a retraction pocket which is filled with keratinous debris. Annual incidence of cholesteatoma is 3 per 100000 in children and 9.2 per 100000 in an adult. 2 Cholesteatoma is formed by a combination of tympanic membrane retraction and basal cell proliferation. There is increased expression of MIB1 in the basement membrane of cholesteatoma. 3 There is proliferating keratinocytes which is localized into small epithelial cones. Epithelial migration pattern is maintained until the retraction pocket deepens and drainage pathway becomes small leading to accumulation of keratin debris. This debris is infected leading to influx of inflammatory calls and production of cytokines. Increased p53 gene proteins prevents cellular proliferation and promote apoptosis. There is an increase in inflammatory markers like Ki67, TNF, caspase 8 leading to increase cell death and accumulation of keratin. Once inflammation is initiated, there is an accumulation of fluid and inflammatory cells in the middle ear cavity, causing ABSTRACT Background: Cholesteatoma term was coined by Johannes Muller in 1838. Cholesteatomas are the last stage of squamous epithelial retraction comprising either the pars tensa or flaccida that are not self-cleansing, which retain epithelial debris and elicit a secondary, inflammatory reaction. Active squamosal epithelial disease is a retraction pocket which is filled with keratinous debris. Methods: 50 patients were selected presenting with active squamosal chronic otitis media (COM). For all cases a detailed history was taken, otoscopic and otomicroscopic examination along with tuning fork test were performed to know the status of tympanic membrane and status of air and bone conduction of sound waves. Audiological assessment was done by pure tone audiometry. X-ray mastoid and high-resolution computed tomography (HRCT) temporal bone was done for analysis. Pre anaesthetic fitness was taken and patients were posted for tympanomastoid exploration. Results: Most common presentation was of foul smelling otorrhoea in 40 patients, reduced hearing in 40 patients. 8 patients presented with vertigo and 2 presented with facial nerve paresis. Most common otoscopic finding was pf postero-superior retraction pocket in 26 patients. After clinical and radiological assessment 30 patients were posted for canal wall down mastoidectomy. Conclusions: Primary acquired cholesteatomacan affect all age group with significant effect on hearing and quality of life. Keywords: Cholesteatoma, Active squamosal disease, Tympanomastoid exploration, Retraction pocket Department of Otorhinolaryngology, Dr. D. Y. Patil Medical College and Hospital, Pune, Maharashtra, India Received: 05 March 2021 Revised: 28 April 2021 Accepted: 29 April 2021 *Correspondence: Dr. Rohit Anand, E-mail: rohit.dr.infi@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/issn.2454-5929.ijohns20211899