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עמוד בית
Thu, 02.02.23

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March 2014
Lela Migirov, Gahl Greenberg, Ana Eyal and Michael Wolf
Cholesteatoma is an epidermoid cyst that is characterized by independent and progressive growth with destruction of adjacent tissues, especially the bone tissue, and tendency to recurrence. Treatment of cholesteatoma is essentially surgical. The choice of surgical technique depends on the extension of the disease, and preoperative otoscopic and radiological findings can be decisive in planning the optimal surgical approach. Cholesteatoma confined to the middle ear cavity and its extensions can be eradicated by use of the minimally invasive transmeatal endoscopic approach. Computerized tomography of the temporal bones fails to distinguish a cholesteatoma from the inflammatory tissue, granulations, fibrosis or mucoid secretions in 20–70% of cases showing opacification of the middle ear and mastoid. Using the turbo-spin echo (TSE), also known as non-echo planar imaging (non-EPI) diffusion-weighted (DW) magnetic resonance imaging, cholesteatoma can be distinguished from other tissues and from mucosal reactions in the middle ear and mastoid. Current MRI sequences can support the clinical diagnosis of cholesteatoma and ascertain the extent of the disease more readily than CT scans. The size determined by the TSE/HASTE (half-Fourier acquisition single-shot turbo-spin echo) DW sequences correlated well with intraoperative findings, with error margins lying within 1 mm. Our experience with more than 150 endoscopic surgeries showed that lesions smaller than 8 mm confined to the middle ear and its extension, as depicted by the non-EPI images, can be managed with transmeatal endoscopic approach solely. We call upon our otolaryngologist and radiologist colleagues to use the newest MRI modalities in the preoperative evaluation of candidates for cholesteatoma surgery.

March 2009
L. Migirov, S. Tal, A. Eyal and J. Kronenberg

Background: Aural cholesteatoma is an epidermal cyst of the middle ear or mastoid that can only be eradicated 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.

Objectives: 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 the patients who had undergone mastoidectomy for cholesteatoma in the past.
 

October 2006
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