Three-dimensional micro-computed tomography analysis of middle ear ossicles in cholesteatoma: morphological insights and clinical implications.

OBJECTIVES: This study's aims were to reconstruct three-dimensional (3D) structures of healthy middle ear ossicles and of ossicles destroyed by cholesteatoma in children and to compare the 3D micro-CT scans and histological findings with a focus on detecting epidermal invasion into the middle ear ossicles. METHODS: Nine middle ear ossicles affected by cholesteatoma obtained during standard surgery were analysed and compared to healthy ossicles harvested from children obtained during facial nerve decompression surgery. The structures of the ossicles were analysed using micro-CT scan and histochemical analysis with a focus on detecting epidermis. RESULTS: Histologically, the surface epithelium (columnar ciliated epithelium) was sporadically present on the surface of the ossicles affected by cholesteatoma (CKAE1/3 positive), but squamous epithelium was not detected (p63 negative). Micro-CT analysis shows pathological changes in the structure of the middle ear ossicles affected by cholesteatoma. CONCLUSION: While 3D micro-CT scans show huge damage of the middle ear ossicles affected by cholesteatoma, no squamous epithelium was detected using histochemical analysis.