Defining the Timing of Radiological Follow-Up for Detection of Cholesteatoma Recidivism: A Meta-analysis

Non-echo-planar diffusion-weighted imaging (non-EPI DWI) magnetic resonance imaging (MRI) has revolutionized postoperative cholesteatoma follow-up, shifting from surgical to radiological evaluation. Yet, the timing for postoperative imaging remains contentious. This meta-analysis assesses the optimal follow-up interval for postoperative MRI in detecting cholesteatoma recidivism.

PubMed, Embase, and Cochrane.

We conducted a meta-analysis systematic review of PubMed, Embase and Cochrane between 2013 and 2024 following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The positive MRI rate over time was estimated for each study separately and then pooled across studies using weighted averages of the ears studied. Data were plotted against time with a smoothed curve and 95% confidence intervals. Study quality was assessed using the Newcastle-Ottawa Scale.

We identified 525 studies, of which 16 studies met the inclusion criteria, comprising 1187 patients. The pooled MRI positivity rates at standardized follow-up intervals were 12% at 1 month, 19% at 6 months, and 15% at 12 months. Positivity increased to 22% at 24 months, then declined to 12% at 36 months, followed by a secondary peak of 21% at 48 months, and 13% at 60 months. Canal wall up procedure demonstrated significantly higher MRI positive rates than obliteration procedures at both 12 months (22% vs 7%) and 36 months (18% vs 9%). At 12 months, the pooled MRI positivity rate was 16% (95% CI: 6%-38%, I² = 91%) in adults and 20% (95% CI: 7%-47%, I² = 88%) in children.

Our findings support performing the first routine non-EPI DWI MRI at 12 to 24 months postoperatively. Given the slow-growing nature of cholesteatoma and stable recurrence rates beyond this period, follow-up imaging can be performed at 2-year intervals thereafter in patients with a negative initial scan, yet continued for at least 5 years.