Are fungi and EBV effective in cholesteatoma etiology?

Abstract

Aim: Cholesteatoma is a commonly seen disease whose pathogenesis remains unknown. Although not a neoplastic process, it may progress to a fatal condition with local bone destruction. In this study, we aimed to present new insights concerning the etiology of cholesteatoma triggered by an inflammatory process.Materials and Methods: The study included 34 patients diagnosed with cholesteatoma upon mastoidectomy performed between 2011-2019. Due to a provisional diagnosis of cholesteatoma. The cases were investigated for the latent membrane protein (LMP-1) encoded by the Epstein-Barr Virus (EBV) using the immunohistochemical method and for the presence of fungi using Grocott’s methenamine silver (GMSII) stain.Results: No fungi was detected in any of the 34 patients by GMSII staining. Thirty-two of the 34 patients were negative with but a suspicious result was seen in 2 patients with the immunohistochemical EBV antibody. EBV-encoded RNA (EBER) analysis was applied to these 2 cases with the silver in situ hybridization method and no reaction was observed.Conclusion: In our study, we investigated the presence of fungi and EBV, which can trigger the inflammatory process. However, no EBV or fungi was detected in the tissues. Our study is the first to investigate the presence of EBV and fungi in formalin-fixed tissue in cases of aggressive cholesteatoma.