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Updated: Sep 5, 2025
Endoscopic Cholesteatoma Surgery
Published on: January 19, 2022
Proposal of a magnetic resonance imaging follow-up protocol after cholesteatoma surgery: a prospective study
Edoardo Covelli1, Valerio Margani1, Chiara Filippi1
1Department of Neuroscience, Mental Health, and Sensory Organs, Sant Andrea Hospital, Sapienza University, Rome, Italy.
Background:
Non-echo planar (EPI) diffusion-weighted (DW) MRI has become an effective tool for the follow-up after cholesteatoma surgery and decreased the rate of second-look surgeries.
Objectives:
To shed light on the optimal imaging follow-up protocol to detect postoperative residual or recurrent cholesteatoma.
Materials And Methods:
64 patients were included in this prospective study. Three different surgical procedures were considered: canal-wall-up (26 patients), canal-wall-down (20 patients), and obliterative (18 patients). The imaging follow-up protocol included non-EPI DW MRI during the following postoperative periods: 1 month, 6 months, and 1, 3, 5, and 7 years after the primary surgery.
Results:
MRI-positive lesions were present in 18.75% of patients. 50% of the MRI-positive findings occurred at the 1-month follow-up. The other peak of MRI positivity occurred at the 3-year follow-up. The last MRI-positive finding appeared at the 5-year follow-up.
Conclusions:
The timing for the imaging protocol proposed by this prospective study to detect recidivism after cholesteatoma surgery stressed the importance of performing non-EPI DW MRI for detecting residual, though rare, disease. Likewise, extending the follow-up to a least 5 years after primary surgery was also recommended to detect any recurrent cholesteatoma that would appear unlikely to be present beyond this time set.
Insights
Non-echo planar diffusion-weighted MRI is crucial for detecting cholesteatoma recurrence after surgery. Extended follow-up to five years is recommended to identify residual or recurrent disease effectively.
Area of Science:
- Radiology
- Otolaryngology
- Medical Imaging
Background:
- Non-echo planar (EPI) diffusion-weighted (DW) MRI is an effective tool for post-cholesteatoma surgery follow-up.
- It has successfully reduced the need for second-look surgeries.
Purpose of the Study:
- To determine the optimal imaging follow-up protocol for detecting residual or recurrent cholesteatoma.
- To establish the most effective timing for non-EPI DW MRI scans after surgery.
Main Methods:
- A prospective study included 64 patients who underwent three types of cholesteatoma surgery: canal-wall-up, canal-wall-down, and obliterative.
- The follow-up protocol involved non-EPI DW MRI at 1 month, 6 months, 1, 3, 5, and 7 years post-surgery.
Main Results:
- MRI-positive findings for residual or recurrent cholesteatoma were observed in 18.75% of patients.
- The majority of positive findings (50%) appeared at the 1-month follow-up, with another peak at 3 years.
- The latest positive finding was detected at the 5-year follow-up.
Conclusions:
- Non-EPI DW MRI is important for detecting residual cholesteatoma, even if rare.
- A follow-up period of at least 5 years is recommended to detect recurrent cholesteatoma.
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