Learning Objectives: Cholesteatoma is not a static condition, and does not develop instantly, changing from the definition of no cholesteatoma to a cholesteatoma all of a sudden. There is gradual transition, from state of cholesteatoma prone conditions to pre-cholesteatoma to cholesteatoma, during which an ear may not fit to the clear definitions. Awareness of this transition may be helpful in identifying the ears that has the risk for cholesteatoma development, and perhaps interventions may moderate or prevent this process.

There is a continuum of conditions from Eustachian tube (ET) dysfunction (ETD) to tympanic membrane (TM) retraction, TM retraction pocket, cholesteatoma prone retraction pocket, pre-cholesteatoma, cholesteatoma, recurrence of ET retraction pocket, recurrence of cholesteatoma. Although this progression of conditions is limited with primary acquired cholesteatoma, it represents majority of the pathogenesis of cholesteatoma cases in both children and adults. While this may be seen as theoretic/logical progression, this transition is observed more clearly in children with recurrent and chronic otitis media with likely underlying ETD followed up by pediatric otolaryngologists through their growth and development.

Current presentation is on the experience with the cholesteatoma prone ears, discussing the definitions, risk factors, management of risk factors, methods of prevention, and the decision making process in assessment and management of ears with retraction pocket, pre-cholesteatoma and early cholesteatoma states that are in transition to cholesteatoma formation.

There is a need for consensus on definitions and classification of these transitional conditions and diagnostic criteria for the underlying ETD, a grading system sensitive in capturing the changes in the state of ears as well as ETD, so that prospective close follow-up generates comparable data for future analysis, making analysis of results from multiple centers and hypothesis driven trials possible.