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Another etiology of middle ear cholesteatoma.

Cholesteatomata have developed away from the annulus in noninfected middle ears which have sustained perforation secondary to blast trauma. In this series of blast perforations, 12% have had epithelium located in the middle ear away from the malleus and annulus. Myringoplasty is contraindicated in the blast perforation; tympanoplasty should not be performed too soon following blast perforation; many blast perforations are never detected since most of them close spontaneously. Viable epithelium certainly may be "locked" medial to an intact tympanic membrane and be the cause of cholesteatoma many years later. These cholesteatomata may even be termed primary by observers who see a normal tympanic membrane and are not aware of blast trauma perforation as a cause of middle ear cholesteatoma.