Auditory Research 2026

Time to Residual Cholesteatoma Detection on Serial Non-EPI DWI MRI: Comparing Pediatric and Adult Patients

Einat Levy 1,2 Aviad Bachar 1,2 Eyal Yosefof 1,2 Dan Yaniv 1,2 Sharon Tzelnick 1,2 Meirav Sokolov 2,3 David Ulanovski 2,3 Eyal Raveh 2,3 Liora Kornreich 2,4 Ohad Hilly 1,2
1Department of Otorhinolaryngology and Head and Neck Surgery, Rabin Medical Center
2Gray Faculty of Medical and Health Sciences, Tel Aviv University, Israel
3Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center, Israel
4Department of Imaging, Schneider Children's Medical Center, Israel

Background

Non-echo-planar diffusion-weighted MRI (Non-EPI DWI MRI) is established for post-operative surveillance of residual cholesteatoma. Recidivism rates are high (10–30%), reportedly more so in children. It is unknown whether residual cholesteatoma growth rate differs between age groups, and consequently what is the ideal timing for MRI-surveillance. This study compared the time to MRI detection of residual cholesteatoma between pediatric and adult patients.

Methods

This retrospective analysis included patients from a single tertiary center with MRI-confirmed residual cholesteatoma following canal wall-up tympanomastoidectomy. Time from surgery to MRI-positive detection was compared between groups.

Results

Thirty-seven patients were identified. Four were excluded because their first post-operative MRI occurred >24 months post-surgery. In the remaining 33 cases (16 children, 17 adults), no significant difference in the timing of residual cholesteatoma detection was found between children and adults (27.9 vs. 31.6 months, respectively; p=0.56). An initially negative MRI preceded eventual residual detection in 56.3% of children (9/16) and 52.9% of adults (9/17). Following negative initial scans, the latest residual detection occurred at 50.60 months in children and 73.92 months in adults.

Conclusion

The time to MRI-detected residual cholesteatoma does not differ significantly between pediatric and adult patients. With mean detection timing between two to three years post surgery, an initial MRI scan during the second year after surgery is reasonable in both groups. Serial MRI surveillance is important since most patients had negative scans prior to their residual cholesteatoma detection, and should continue for more than five years.