Secondary acquired cholesteatoma after myringotomy with or without tympanostomy tube insertion

Secondary acquired cholesteatoma in two different children. Panel A shows a cholesteatoma (arrows) in a child who previously underwent TT insertion; panel B shows a cholesteatoma (thick arrows) in a child who previously underwent myringotomy (m) without TT insertion. Secondary acquired cholesteatoma is a rare complication of myringotomy and TT insertion. It is believed to result from the migration of tympanic membrane keratinocytes into the middle ear from the margins of a chronic perforation or along the shaft of a TT.