Thus, given the complexity of the pathogenesis of cholesteatoma, the aim of this study was to compare the distribution of proliferation markers (Ki-67, NF-κβ), tissue-remodeling factors (MMP-2, MMP-9, TIMP-2, TIMP-4), vascular endothelial growth factor (VEGF), pro-and anti-inflammatory cytokines (IL-1, IL-10), defensins (HβD-2, HβD-4) and Shh gene protein in cholesteatoma and control skin tissue. The gene discussed is TIMP4; the disease is cholesteatoma.