Comparison of Middle Ear Cholesteatoma Recurrences after Canal Wall Down and Canal Wall Up Mastoidectomy Based on Diffusion-Weighted MRI

Abstract

Background: Middle ear cholesteatoma is a disease that is often recurs. However, the suspicion of recurrent cholesteatoma is still difficult  to confirm based on the clinical picture in  cases with granulation tissue ; therefore magnetic resonance imaging diffusion-weighted imaging (MRI- DWI) examination is required. MRI-DWI  have been used to identifysuch lesions.  

Objective: To detect early recurrences of cholesteatoma in patients after canal wall down (CWD) and canal wall up (CWU) mastoidectomy based on MRIDWI.

Methods: This was a prospective cohort study of  an observational analytical nature. Held at the ENT-HNS at two tertiary teaching hospitals, Hasanuddin University Hospital and Dr. Wahidin Sudirohusodo Hospital,from April 2023 to October 2023. The sample for this study was patients with  chronic suppurative otitis media (CSOM) cholesteatoma who had undergone CWD or CWU mastoidectomy with symptoms of otorrhea, granulation, and extended healing wounds. Patients with contraindications to MRIDWI examinations were excluded from this study. Each patient underwent otoendoscopy. Tuning fork tests and pure-tone audiometry were also performed. Then, an MRI DWI examination was carried out on all study samples at least 6 months after the first mastoidectomy.

Results: Twenty patients were included in this study . The majority (12/20) of the patients were men. Ten patients underwent CWD, and 10 patients had undergone CWU. Recurrence occurred in 11 patients (55.0%). In post-CWD mastoidectomy patients, Only 40.0% experienced recurrence. Meanwhile, 70% of  post-CWU patients, experienced recurrence, although this difference was not significant (p=0.370).

Conclusion: CWU mastoidectomy was associated with a higher risk of  cholesteatoma  recurrence. MRI DWI is an ideal methods to identify early recurrent middle ear cholesteatoma.