Abstract
A cholesteatoma is a mass of keratinising epithelium in the middle ear. It is a rare disorder that is associated with significant morbidity, and its causative risk factors are poorly understood; on a global scale, up to a million people are affected by this each year. We have conducted a systematic literature review to identify reports about the heritability of cholesteatoma or any constitutional genetic factors that may be associated with its aetiology. A systematic search of MEDLINE (EBSCO) and two databases of curated genetic research (OMIM and Phenopedia) was conducted. The participants and populations of interest for this review were people treated for cholesteatoma and their family members. The studies of interest reported evidence of heritability for the trait, or any association with congenital syndromes and particular genetic variants. The searches identified 449 unique studies, of which 35 were included in the final narrative synthesis. A narrative synthesis was conducted, and data were tabulated to record characteristics, including study design, genetic data and author conclusions. Most of the studies identified in the literature search, and described here, are case reports and so represent the lowest level of evidence. In a few case reports, congenital and acquired cholesteatomas have been shown to segregate within families in the pattern typical of a monogenic or oligogenic disorder with incomplete penetrance. Evidence from syndromic cases could suggest that genes controlling ear morphology may be risk factors for cholesteatoma formation. This is the first systematic review about the genetics of cholesteatoma, and we have identified a small body of relevant literature that provides evidence of a heritable component for its aetiology. Cholesteatoma is a complex and heterogeneous clinical phenotype, and it is often associated with chronic otitis media and with some rare congenital syndromes known to affect ear morphology and related pathologies.
Highlights
A cholesteatoma is a self-perpetuating erosive lesion composed of stratified keratinising squamous epithelium in the middle ear.1 Cholesteatoma has both an acquired and a congenital form
In a few case reports, congenital and acquired cholesteatomas have been shown to segregate within families in the pattern typical of a monogenic or oligogenic disorder with incomplete penetrance
In a handful of case reports or case series, congenital and acquired cholesteatomas have been shown to segregate within families in the pattern typical of a monogenic or oligogenic disorder with incomplete penetrance
Summary
A cholesteatoma is a self-perpetuating erosive lesion composed of stratified keratinising squamous epithelium in the middle ear. Cholesteatoma has both an acquired and a congenital form. A cholesteatoma is a self-perpetuating erosive lesion composed of stratified keratinising squamous epithelium in the middle ear.1 Cholesteatoma has both an acquired and a congenital form. A typical sequence of events in the onset of the disease includes a history of chronic otitis media (COM) in childhood, subsequent development of retraction of the tympanic membrane and a cholesteatoma developing within and perforating through this retraction. This seems to occur if the retraction is located in the superior tympanic membrane (pars flaccida).. Those who develop cholesteatoma have been reported to have between a 7% and a 20% chance of developing disease in the contralateral ear, highlighting the importance of shared genes and shared environments
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