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Twenty-nine cases of acquired MEC and eight cases of healthy middle ears undergoing cochlear implantation (CI) were evaluated. Full-length 16S rRNA gene sequencing was performed to profile the bacterial communities in lesions and healthy tissues of the middle ear. ACE (<jats:italic>P<\/jats:italic> = 0.043) and Chao1 (<jats:italic>P<\/jats:italic> = 0.039) indices showed significant differences in alpha diversity (<jats:italic>P<\/jats:italic> &lt; 0.05). Analysis of PERMANOVA\/Anosim using the <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/en.wikipedia.org\/wiki\/Bray%E2%80%93Curtis_dissimilarity\">Bray\u2013Curtis<\/jats:ext-link> distance matrix results suggested that the between-group differences were greater than the within-group differences (<jats:italic>R<\/jats:italic> = 0.238, <jats:italic>P<\/jats:italic> &lt; 0.05, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup> = 0.066, <jats:italic>P<\/jats:italic> &lt; 0.05). Bacterial community analysis revealed that <jats:italic>Alphaproteobacteria<\/jats:italic> at the class level and <jats:italic>Caulobacterales<\/jats:italic> and <jats:italic>Sphingomonadales<\/jats:italic> at the order level were significantly different (<jats:italic>P<\/jats:italic> &lt; 0.05). In the LefSe (Linear discriminant analysis effect size) analysis, <jats:italic>Porphyromonas bennonis<\/jats:italic> was elevated, and <jats:italic>Bryum argenteum<\/jats:italic> and unclassified <jats:italic>Cyanobacteriales<\/jats:italic> were reduced at the species level in MEC (<jats:italic>P<\/jats:italic> &lt; 0.05). Fifteen metabolic pathways were found to be significantly different between the two groups by analysing the abundance of metabolic pathways in level 2 of the Kyoto Encyclopaedia of Genes and Genomes (KEGG). Seven and eight metabolic pathways were significantly elevated in the MEC and control groups, respectively (<jats:italic>P<\/jats:italic> &lt; 0.05). The role of bacteria in the pathogenesis of acquired MEC was further refined through analysis of metabolic pathways. These findings indicate that the acquired MEC and healthy middle ear contain more diverse microbial communities than previously thought.<\/jats:p>","DOI":"10.1007\/s10142-023-01068-2","type":"journal-article","created":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T18:12:19Z","timestamp":1682619139000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Bacterial diversity of middle ear cholesteatoma by 16S rRNA gene sequencing in China"],"prefix":"10.1007","volume":"23","author":[{"given":"Qiulin","family":"Liang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiqing","family":"Long","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuling","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaowu","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingyu","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuohui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biao","family":"Ruan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,4,27]]},"reference":[{"key":"1068_CR1","first-page":"235","volume":"158","author":"P Bel\u00e1kov\u00e1","year":"2019","unstructured":"Bel\u00e1kov\u00e1 P, St\u00e1rek I, Salzman R, Hyrav\u00fd M (2019) Chronic inflammation of the middle ear with cholesteatoma. 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