Palaeo-otology of cholesteatoma

A cholesteatoma is a collection of dead epithelial cells in the ear which becomes infected with low-grade pathogenic microorganisms. The lesion tends to cause resorption of the surrounding bone, which potentially permits its recognition in skeletal remains. Cholesteatoma may occur in the middle or the outer ear. Using two examples of cholesteatoma in skeletal remains from British archaeological sites, the differential diagnosis of cholesteatoma from other aural diseases is demonstrated. Some of the differences in bony lesions caused by middle ear and external ear canal cholesteatoma which may enable the two to be distinguished in palaeopathological specimens are discussed. Attention is drawn towards the importance of making this distinction in ancient skeletal remains; middle ear and external ear canal cholesteatoma have a different array of causes and very different impacts upon health status.