Tubal dysfunction was studied histologically in human adults. Malfunction of the auditory tube may cause the development of the adhesive process and the retraction pocket. The retraction pocket is the precursor of cholesteatoma, because it presents the best conditions for the epithelial ingrowth. Granulation tissue within the tympanic cleft is the nutritive basis for the so-called matrix and allows the growth of the cholesteatoma. A cholesteatoma may develop in spite of an intact membrane if the pars fibrosa is lacking. Such a cholesteatoma pushes inward the distended tympanic membrane or its remnants. Resisting structures, e.g., the enwrapped long process of incus, the malleus or the tensor tendon, allow the neck formation of the cholesteatoma. Serotubotympanitic catarrh and otitis media adhesiva lead to adhesive process and cholesteatoma. The starting point is a tubal malfunction.