A Wait and Scan Protocol for Asymptomatic Postsurgical Cholesteatoma Recurrence: A Novel Management Strategy

Area of Science:

• Otolaryngology
• Diagnostic Imaging
• Surgical Oncology

Background:

• Postoperative cholesteatoma recurrence requires vigilant monitoring.
• Immediate surgical re-exploration carries risks and may not always be necessary for small, asymptomatic recurrences.
• Non-echo-planar diffusion-weighted MRI is a key tool for detecting cholesteatoma recurrence.

Purpose of the Study:

• To assess the feasibility and safety of active MRI surveillance for managing small, asymptomatic postoperative cholesteatoma recurrence.
• To determine if MRI surveillance can serve as a viable alternative to immediate surgical re-exploration.
• To evaluate the outcomes of active surveillance, including surgery-free survival and lesion growth rate.

Main Methods:

• Prospective, single-arm pilot study conducted at a secondary referral otology center.
• Included patients with ≤5 mm asymptomatic postoperative cholesteatoma recurrence on MRI, without critical structure proximity.
• Employed structured active surveillance with serial non-echo-planar diffusion-weighted MRI scans at 12-18 month intervals.

Main Results:

• Thirteen patients were followed for a mean of 43 months; 77% remained surgery-free.
• The mean lesion growth rate was 0.32 mm/year, with 23% showing spontaneous regression.
• Kaplan-Meier analysis showed 100% surgery-free survival at 24 months and 91% at 36 months.

Conclusions:

• Active MRI surveillance is a feasible and safe strategy for selected patients with small, asymptomatic postoperative cholesteatoma recurrence.
• This approach can defer the need for surgical re-exploration.
• Further research into imaging-guided surveillance for MRI-detected recurrence is warranted.