Pathogenic factors in bone resorption in cholesteatoma.

Factors present in skin appear to enhance bone resorption in chronic otitis media. These skin factors were replicated in a series of experiments using an animal model. The presence of activated granulation tissue is a universal finding in bone resorption in otitis media. Skin promotes bone resorbing connective tissue by the action of keratin as a foreign body, by the enhancement of middle ear sepsis, by stimulation and activation of inflammatory cells and most importantly through the creation of pressure.