In reference to A new theory on the pathogenesis of acquired cholesteatoma: Mucosal traction.

tympanic membrane is pulled up into the attic by traction caused by 1) epithelial migration and 2) the movement of a mucociliary blanket propelled by ciliary action. The proposal is logical and supported by some experimental evidence that there is evidence epithelial migration of the mucosal side of the pars tensa in an experimental animal. Fig. 1. The distribution of ciliated cells in the human middle ear (Shimada & Lim, 1972; used with permission). Fig. 2. Photomicrographs of the pars flaccida and the lateral surface of the incus demonstrating flat epithelial cells without ciliated cells in a normal human temporal bone. The arrows indicate the squamous epithelium without the presence of ciliated cells or goblet cells.