A person's hearing and balance may be impacted by a number of issues and difficulties brought on by persistent middle ear inflammation.

A common issue is the development of cholesteatomas, which are aberrant ear collections of cells that, if addressed, can lead to bone erosion. Consequently, this may result in symptoms including vertigo, facial paralysis, hearing loss, and even brain infection.

In a study published recently in Nature Communications, researchers from Osaka University have revealed the cause of cholesteatomas, which may help in developing new therapies for patients who are suffering from this disease.  

Cholesteatomas are made up of cysts or bumps in the ear that consists of skin, collagen fibres, skin cells, fibroblasts, keratin, and dead tissue.

There are many theories on how these cholesteatomas can cause bone erosion, including the activation of cells responsible for the breakdown of the minerals and matrix of the bone, the presence of inflammatory markers and enzymes, and the accumulation and pressure from dead cells and tissues in the ear; however, the exact mechanism for the creation of cholesteatomas remains unknown.

“A cholesteatoma can still return or happen again even after its surgical removal, so it is important to know what is actually causing it,” says lead author Kotaro Shimizu.

To investigate this, researchers looked at human cholesteatoma tissues that were surgically removed from patients. A process called single-cell RNA sequencing analysis was employed to identify cells responsible for triggering bone erosion; these were called osteoclastogenic fibroblasts.

This study demonstrated how these fibroblasts expressed an abundant amount of activin A, a molecule that regulates different physiologic functions of the body.

The presence of activin A is said to cause bone erosion through a process in which specialised cells initiate bone resorption through a process wherein the minerals and matrix of the bones are broken down and absorbed by the body.