Middle ear cholesteatoma epithelium is a rich source of interleukin-1-alpha (IL-1-alpha), being involved in both keratinocyte hyperproliferation and bone destruction. IL-1-alpha exerts its effects by binding to two distinct IL-1 receptors (IL-1-R). In this study, we have examined the expression of IL-1-R type II (IL-1-R-II) in cholesteatoma samples and have quantified these levels with computer-assisted image analysis. Normal aural skin was used as control. Immunostaining demonstrated the presence of IL-1-R-II in both epidermis and cholesteatoma keratinocytes. The receptors were 3 times higher than those in normal epidermis. The presence of IL-1-alpha in cholesteatoma epithelium coupled with the induced expression of IL-1-R-II indicates the existence of a highly regulated system of autocrine stimulation of cholesteatoma keratinocytes by IL-1.