title: Residual cholesteatoma: prevalence and location. Follow-up strategy in adults.
abstract: OBJECTIVE
  To assess prevalence and location of residual cholesteatoma following closed "canal wall up" tympanoplasty (CWUT). The evolution of follow-up strategy is discussed.
  
  
  METHODS
  A retrospective study was run in adults operated on by CWUT for middle-ear cholesteatoma and who had undergone second look surgery and/or postoperative radiology (CT-scan, diffusion-weighted MRI).
  
  
  RESULTS
  One hundred and nine patients (113 ears) underwent the procedure. Mean follow-up was 48 months (range, 24-96 months). Twenty-nine residual cholesteatomas were found (25%), including 11 located in the anterior attic (38%). Follow-up included 77 second look operations (70%), and 71 radiological examinations (62 CT-scans and nine diffusion-weighted MRIs). Second look surgery was without benefit for the patient (no residual, no ossiculoplasty) in one third of cases.
  
  
  CONCLUSIONS
  Residual cholesteatoma in the anterior attic is a problem in CWUT. When postoperative auditory results are good, second look surgery should not be systematic but guided by high quality imaging.
authors.affiliation: Service ORL et chirurgie cervicofaciale, hôpital Bretonneau, CHRU de Tours, 37044 Tours cedex 9, France. lgailorl@gmail.com
authors.forename: L
authors.initials: L
authors.lastname: Gaillardin
authors.forename: E
authors.initials: E
authors.lastname: Lescanne
authors.forename: S
authors.initials: S
authors.lastname: Morinière
authors.forename: J-P
authors.initials: JP
authors.lastname: Cottier
authors.forename: A
authors.initials: A
authors.lastname: Robier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018424:Cholesteatoma, Middle Ear / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D003430:Cross-Sectional Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D019933:Ossicular Replacement; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed; D014433:Tympanoplasty / Q000379:methods