A down-regulation of TLR4 was seen in middle ear mucosa from a group of patients with CMED, including cholesteatoma [16] and an up-regelation of TLR2 and 4 in immunohistochemical analysis in tissue samples from five cholesteatoma patients, in comparison to normal mucosa [17], was detected respectively. The gene discussed is TLR4; the disease is cholesteatoma.