MRI, not CT, to rule out recurrent cholesteatoma and avoid unnecessary second-look mastoidectomy.
BACKGROUND
Aural cholesteatoma is an epidermal cyst of the middle ear or mastoid that can be eradicated only by surgical resection. It is usually managed with radical or modified radical mastoidectomy. Clinical diagnosis of recurrent cholesteatoma in a closed postoperative cavity is difficult. Thus, the accepted protocol in most otologic centers for suspected recurrence consists of second-look procedures performed approximately 1 year after the initial surgery. Brain herniation into a post-mastoidectomy cavity is not rare and can be radiologically confused with cholesteatoma on the high resolution computed tomographic images of temporal bones that are carried out before second-look surgery.


OBJECTIVE
To present our experience with meningoceles that were confused with recurrent disease in patients who had undergone primary mastoidectomy for cholesteatoma and to support the use of magnetic resonance imaging as more suitable than CT in postoperative follow-up protocols for cholesteatoma.


METHODS
We conducted a retrospective chart review of four patients.


RESULTS
Axial CT sections demonstrated a soft tissue mass in the middle ear and mastoid in all four patients. Coronal reconstructions of CT scans showed a tympanic tegmen defect in two patients. CT failed to exclude cholesteatoma in any patient. Each underwent a second-look mastoidectomy and the only finding at surgery was meningocele in all four patients.


CONCLUSIONS
Echo-planar diffusion-weighted MRI can differentiate between brain tissue and cholesteatoma more accurately than CT. We recommend that otolaryngologists avoid unnecessary revision procedures by using the newest imaging modalities for more precise diagnosis of patients who had undergone mastoidectomy for cholesteatoma in the past.
Migirov
Lela
L
Department of Otolaryngology, Sheba Medical Center, Tel Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. sabim@bezeqint.net
Tal
Sigal
S
Eyal
Ana
A
Kronenberg
Jona
J
D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D004432:Ear, Middle / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008416:Mastoid / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D012008:Recurrence; D024162:Second-Look Surgery; D014057:Tomography, X-Ray Computed