White pea-like material seen in the flaccid portion of the tympanic membrane is one of the characteristic symptoms of cholesteatoma of the middle ear.
Cholesteatoma of the middle ear is a cystic structure formed by keratinized squamous epithelium in the middle ear, and white epithelial tissue is often accumulated in the middle. If a white pea-like substance is seen in the flaccid portion of the tympanic membrane, it is mainly due to the epithelium of the tympanic membrane or external auditory canal that has become trapped in the tympanic chamber. It may be due to cholesteatoma where the tympanic membrane invaginates to form a sac prior to infection. It may be secondary to inflammation such as perforation of the tympanic membrane where the rim of the epithelium turns into the tympanic cavity.
Eustachian tube malfunction triggers negative pressure within the tympanic cavity, leading to invagination of the flaccid tympanic membrane and formation of an upper tympanic chamber cholesteatoma. Some types are formed after perforation of the tympanic membrane, where the epithelium at the edge of the perforation turns into the tympanic chamber. Inflammatory stimuli in the external auditory canal and middle ear may also cause cholesteatoma formation after the mucosal epithelium of the tympanic chamber has metaplasia into keratinized squamous epithelium. Or it may be caused by abnormal proliferation of epithelium in the deeper parts of the external auditory canal and tympanic membrane.
After the formation of middle ear cholesteatoma, it can be seen in the inlet of the flaccid portion of the internal pocket or the posterior and superior portion of the tense portion of the tympanic membrane, and can be seen in the internal pocket of the white detached epithelium, which resembles a white soya bean dregs-like substance. When there are polypoid granules in the external auditory canal, cholesteatoma often exists in the depth.
When white scum-like material is found in the flaccid part of the eardrum, it is advisable to consult a doctor for a systematic examination in order to clarify the diagnosis and cause of the disease.