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Mirko Tos - One of the best experts on this subject based on the ideXlab platform.
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ten year results of cartilage palisades versus fascia in eardrum reconstruction after surgery for sinus or tensa retraction Cholesteatoma in children
Laryngoscope, 2009Co-Authors: Per Cayethomasen, Janne Andersen, Cem Uzun, Soren Hansen, Mirko TosAbstract:Objectives/Hypothesis: To compare cartilage palisades with fascia grafting in reconstruction of the eardrum after surgery for sinus or tensa retraction Cholesteatoma in children, with respect to long-term postoperative eardrum retraction and perforation, Cholesteatoma recurrence, and hearing acuity. Methods: A total of 64 children underwent surgery for either sinus or tensa retraction Cholesteatoma during the period 1995 to 2000 (mean age 9 years, range 5–15). The eardrum was reconstructed using cartilage palisades in 32 children (32 ears) and fascia or perichondrium in 32 children (33 ears). The patients were followed for at least one year postoperatively and re-evaluated 4 years after surgery, and again recently at a mean of 10 years. The main outcome measures were postoperative drum retraction and perforation, Cholesteatoma recurrence, and hearing acuity (pure tone average, speech reception threshold, and pure tone air-bone gap). Results: All but two patients in both groups attended the 10-year follow-up examination (94% attendance). The mean overall follow-up period was 119 months (115 months in the palisade and 125 months in the fascia group). Total number of retractions during follow-up and at the 10-year examination was six (19%) for the palisade group and 14 (42%) for the fascia group (P = .03; chi-square test). The accumulated numbers for a perforation were four (13%) for the palisade group and seven (21%) for the fascia group (difference not significant). Two residual Cholesteatomas, which are not related to the graft material, occurred in the palisade group (6%), whereas both recurrencies, which may be related to the graft material, occurred in the fascia group (6%). The hearing acuity for children operated on for a sinus Cholesteatoma and for children with type III tympanoplasties was significantly better when cartilage palisade grafting had been employed. Conclusions: The cartilage palisade grafting technique appears superior with respect to prevention of long-term eardrum retraction. The occurrence of Cholesteatoma recurrency and eardrum perforation seem to be independent of grafting material, although these results may be due to type 2 error (low number of ears). In sinus Cholesteatoma surgery and in type III tympanoplasty, the long-term hearing results appear better when grafting cartilage palisades. Laryngoscope, 2009
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pathogenesis of attic Cholesteatoma clinical and immunohistochemical support for combination of retraction theory and proliferation theory
American Journal of Otology, 2000Co-Authors: Holger Sudhoff, Mirko TosAbstract:Objective: The aim of the current study was to provide support for a combination of the retraction and proliferation theories of acquired Cholesteatoma. Background: There is clinical evidence for formation of a retraction, but there is a lack of explanation for the transition from a retraction pocket to an active and expanding attic Cholesteatoma. Methods: Epidemiologic studies on the incidence of attic retractions and follow-up studies on patients with attic retractions were performed. Additionally, expression of proliferation marker and analysis of basement membrane were studied in samples of attic Cholesteatoma. Results: The prevalence of attic retractions was between 14% and 25% of investigated ears. In children with manifest secretory otitis, there were some attic Cholesteatomas and 5% to 6% severe retractions. Some of them became preCholesteatomas. requiring treatment and controls. Immunohistochemistry of attic Cholesteatomas showed that proliferating keratinocytes were very often seen within epithelial cones growing toward the underlying stroma. These growth cones exhibited focal discontinuities of the basement membrane, especially in areas of intense subepithelial inflammation. Conclusions: As a possible explanation based on clinical and immunohistochemical findings, the authors propose a four-step concept for the pathogenesis of Cholesteatoma that combines the retraction and proliferation theories: (a) the retraction pocket stage; (b) the proliferation stage of the retraction pocket. subdivided into cone formation and cone fusion; (c) the expansion stage of attic Cholesteatoma; and (d) bone resorption.
Per Cayethomasen - One of the best experts on this subject based on the ideXlab platform.
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ten year results of cartilage palisades versus fascia in eardrum reconstruction after surgery for sinus or tensa retraction Cholesteatoma in children
Laryngoscope, 2009Co-Authors: Per Cayethomasen, Janne Andersen, Cem Uzun, Soren Hansen, Mirko TosAbstract:Objectives/Hypothesis: To compare cartilage palisades with fascia grafting in reconstruction of the eardrum after surgery for sinus or tensa retraction Cholesteatoma in children, with respect to long-term postoperative eardrum retraction and perforation, Cholesteatoma recurrence, and hearing acuity. Methods: A total of 64 children underwent surgery for either sinus or tensa retraction Cholesteatoma during the period 1995 to 2000 (mean age 9 years, range 5–15). The eardrum was reconstructed using cartilage palisades in 32 children (32 ears) and fascia or perichondrium in 32 children (33 ears). The patients were followed for at least one year postoperatively and re-evaluated 4 years after surgery, and again recently at a mean of 10 years. The main outcome measures were postoperative drum retraction and perforation, Cholesteatoma recurrence, and hearing acuity (pure tone average, speech reception threshold, and pure tone air-bone gap). Results: All but two patients in both groups attended the 10-year follow-up examination (94% attendance). The mean overall follow-up period was 119 months (115 months in the palisade and 125 months in the fascia group). Total number of retractions during follow-up and at the 10-year examination was six (19%) for the palisade group and 14 (42%) for the fascia group (P = .03; chi-square test). The accumulated numbers for a perforation were four (13%) for the palisade group and seven (21%) for the fascia group (difference not significant). Two residual Cholesteatomas, which are not related to the graft material, occurred in the palisade group (6%), whereas both recurrencies, which may be related to the graft material, occurred in the fascia group (6%). The hearing acuity for children operated on for a sinus Cholesteatoma and for children with type III tympanoplasties was significantly better when cartilage palisade grafting had been employed. Conclusions: The cartilage palisade grafting technique appears superior with respect to prevention of long-term eardrum retraction. The occurrence of Cholesteatoma recurrency and eardrum perforation seem to be independent of grafting material, although these results may be due to type 2 error (low number of ears). In sinus Cholesteatoma surgery and in type III tympanoplasty, the long-term hearing results appear better when grafting cartilage palisades. Laryngoscope, 2009
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a comparison of cartilage palisades and fascia in tympanoplasty after surgery for sinus or tensa retraction Cholesteatoma in children
Otology & Neurotology, 2004Co-Authors: Joanne Anderson, Per CayethomasenAbstract:OBJECTIVE: To compare cartilage palisades with fascia grafting in reconstruction of the eardrum after surgery for sinus or tensa retraction Cholesteatoma in children, with respect to postoperative drum retraction and perforation, Cholesteatoma recurrence, and hearing. MATERIAL: From March 1995 to October 2000, a total of 64 children, aged 5 to 15 years, underwent surgery for either sinus or tensa retraction Cholesteatoma. The eardrum was reconstructed using cartilage palisades in 32 children and fascia or perichondrium in 32 children. Postoperatively, the patients were seen as out-patients and were recently reevaluated by otomicroscopy and audiometry. MAIN OUTCOME MEASURES: Postoperative drum retraction and perforation, Cholesteatoma recurrence, and hearing (pure tone average, speech reception threshold, and air-bone gap). RESULTS: All patients in the palisade group and all but one patient in the fascia group attended the follow-up examination. In the palisade group, the mean follow-up period was 37 months (range, 3-65 mo) and in the fascia group 52 months (range, 17-75 mo). Two (6%) retractions and no perforations were found in the palisade group, versus 12 (36%) retractions and 4 perforations (12%) in the fascia group at follow-up (both significant differences). No Cholesteatoma recurrence occurred. Late hearing results in sinus Cholesteatomas were significantly better in the palisade group. CONCLUSIONS: The comparison of fascia and cartilage palisade grafting for drum reconstruction after tensa Cholesteatoma surgery in children indicates that the palisade technique may be superior in respect to prevention of drum retraction and perforation. Further, in sinus Cholesteatoma surgery, the long-term hearing results are better when grafting cartilage palisades.
Jan Casselman - One of the best experts on this subject based on the ideXlab platform.
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long term follow up after bony mastoid and epitympanic obliteration radiological findings
Journal of Laryngology and Otology, 2010Co-Authors: Jeanphilippe Vercruysse, Bert De Foer, Thomas Somers, Jan Casselman, Erwin OffeciersAbstract:Objective:The canal wall up bony obliteration technique lowers the incidence of recurrent Cholesteatoma, but carries the potential risk of obliterating residual Cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent Cholesteatoma. Patients: Fifty-one patients presenting with a Cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8-113.6 months). Intervention: All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging). Results: Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex Cholesteatoma. On high resolution Computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three Cholesteatomas, and differentiated them from other associated soft tissues. No Cholesteatoma was found within the obliterated mastoids. Conclusion: Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent Cholesteatoma and to reconstruct unstable Cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but Could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging Succeeded in differentiating soft tissues, enabling detection of residual or recurrent Cholesteatoma after a canal wall up bony obliteration technique procedure.
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detection of postoperative residual Cholesteatoma with non echo planar diffusion weighted magnetic resonance imaging
Otology & Neurotology, 2008Co-Authors: Bert De Foer, Jeanphilippe Vercruysse, Thomas Somers, Jan Casselman, A Bernaerts, F Deckers, Marc Pouillon, Erwin OffeciersAbstract:Objective The aim of this study was to analyze the role of non-echo-planar imaging (non-EPI)-based diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of residual Cholesteatoma after canal wall-up mastoidectomy before eventual second-look surgery. Study design Prospective and blinded study. Setting Tertiary referral center. Patients The study group included the surgical, clinical, and imaging follow-up of 32 consecutive patients after primary Cholesteatoma surgery. Interventions All patients were investigated with MRI, including late postgadolinium T1-weighted sequence and non-EPI-DW sequence, 10 to 18 months after first-stage Cholesteatoma surgery by experienced surgeons using a canal wall-up mastoidectomy. The non-EPI-DW images were evaluated for the presence of a high-signal intensity lesion consistent with residual Cholesteatoma. Imaging findings were correlated with findings from second-stage surgery in 19 patients, clinical follow-up examination in 11 patients, and, in 2 patients, clinical and MRI follow-up examination. Results Non-EPI-DW sequences depicted 9 of 10 residual Cholesteatomas. The only lesion missed was a 2-mm Cholesteatoma in an examination degraded by motion artifacts in a child. All other diagnosed Cholesteatomas measured between 2 and 6 mm. Sensitivity, specificity, positive predictive value, and negative predictive value were 90, 100, 100, and 96%, respectively. Conclusion Except for motion artifact-degraded examinations, non-EPI-DW MRI is able to detect even very small residual Cholesteatoma after first-stage surgery by showing a high-signal intensity lesion. It has the capability of selecting patients for second-look surgery, avoiding unnecessary second-look surgery.
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the value of single shot turbo spin echo diffusion weighted mr imaging in the detection of middle ear Cholesteatoma
Neuroradiology, 2007Co-Authors: Bert De Foer, Jeanphilippe Vercruysse, Thomas Somers, Erwin Offeciers, A Bernaerts, Joachim Maes, F Deckers, Johan Michiels, Marc Pouillon, Jan CasselmanAbstract:Introduction Single-shot (SS) turbo spin-echo (TSE) diffusion-weighted (DW) magnetic resonance imaging (MRI) is a non echo-planar imaging (EPI) technique recently reported for the evaluation of middle ear Cholesteatoma. We prospectively evaluated a SS TSE DW sequence in detecting congenital or acquired middle ear Cholesteatoma and evaluated the size of middle ear Cholesteatoma detectable with this sequence. The aim of this study was not to differentiate between inflammatory tissue and Cholesteatoma using SS TSE DW imaging. Methods A group of 21 patients strongly suspected clinically and/or otoscopically of having a middle ear Cholesteatoma without any history of prior surgery were evaluated with late post-gadolinium MRI including this SS TSE DW sequence. Results A total of 21 middle ear Cholesteatomas (5 congenital and 16 acquired) were found at surgery with a size varying between 2 and 19 mm. Hyperintense signal on SS TSE DW imaging compatible with Cholesteatoma was found in 19 patients. One patient showed no hyperintensity due to autoevacuation of the Cholesteatoma sac into the external auditory canal. Another patient showed no hyperintensity because of motion artifacts. Conclusion This study shows the high sensitivity of this SS TSE DW sequence in detecting small middle ear Cholesteatomas, with a size limit as small as 2 mm.
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value of high resolution computed tomography and magnetic resonance imaging in the detection of residual Cholesteatomas in primary bony obliterated mastoids
American Journal of Otolaryngology, 2007Co-Authors: Bert De Foer, Jeanphilippe Vercruysse, Thomas Somers, Jan Casselman, Marc Pouillon, Erwin OffeciersAbstract:Purpose: The objective of this study was to assess the value of high-resolution computed tomography (HRCT) and that of magnetic resonance imaging (MRI), including postcontrast T1weighted images and echo-planar diffusion-weighted (EP-DW) images, in the detection of residual Cholesteatomas after primary bony obliteration of the mastoid. Patients and methods: Twenty-three patients underwent a second-look surgery 8 to 18 months after they underwent a primary bony obliteration technique. All patients were evaluated by HRCT and MRI before their second-look surgery. A retrospective analysis was performed. Results: A residual Cholesteatoma was found in 2 of the 23 patients; both cases of Cholesteatoma had a diameter less than 4 mm. In these 2 patients, residual Cholesteatoma was found in the middle ear cavity and not in the obliterated mastoid. In all cases, HRCT showed a homogeneous obliteration of the mastoid cavity. On MRI, only one Cholesteatoma pearl was detected using contrast-enhanced T1weighted imaging. Findings from the EP-DW imaging were negative for all cases. Conclusion: This study demonstrates that HRCT is still the imaging technique of choice for the evaluation of bony obliterated mastoids. It shows the low sensitivity and specificity of HRCT for the characterization of an associated opacified middle ear and those of contrast-enhanced T1weighted imaging and EP-DW imaging for the detection of small residual Cholesteatomas after primary bony obliteration. D 2007 Published by Elsevier Inc.
H Deramond - One of the best experts on this subject based on the ideXlab platform.
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3t mr imaging of postoperative recurrent middle ear Cholesteatomas value of periodically rotated overlapping parallel lines with enhanced reconstruction diffusion weighted mr imaging
American Journal of Neuroradiology, 2008Co-Authors: P Lehmann, Guillaume Saliou, C Brochart, C Page, B Deschepper, J N Vallee, H DeramondAbstract:BACKGROUND AND PURPOSE: MR diagnostic of postoperative recurrent Cholesteatomas is difficult. Our purpose was to compare multishot fast spin-echo periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) diffusion-weighted MR imaging (DWI) with array spatial sensitivity encoding technique (ASSET) single-shot echo-planar DWI and late postgadolinium T1-weighted MR imaging for the detection of postoperative recurrent middle ear Cholesteatomas with a 3T imaging unit. MATERIALS AND METHODS: Thirty-five patients with suggested postoperative recurrent middle ear Cholesteatoma underwent 3T MR imaging with PROPELLER DWI, ASSET echo-planar DWI, and late postgadolinium T1-weighted MR imaging. Three radiologists (2 seniors, 1 fellow) analyzed unlabeled images for visualization of recurrence. Interobserver and intraobserver agreement was assessed by using the Cohen κ statistic test. Sensitivity, specificity, and predictive value were assessed for the 3 observers. RESULTS: Nineteen recurrent Cholesteatomas were diagnosed. PROPELLER interobserver agreement was very good (1, 0.89, 0.89) among the 3 observers. Intraobserver agreement between PROPELLER and T1-weighted imaging was very good to moderate (0.88, 0.57, 0.58). PROPELLER DWI provided less interobserver variability than other sequences, and the best sensitivity, specificity, and predictive value. CONCLUSIONS: On a 3T imaging unit, multishot fast spin-echo PROPELLER DWI allows an easier detection of postoperative recurrent middle ear Cholesteatoma than T1-weighted imaging by reducing artifacts and by its better contrast. DWI with PROPELLER is diagnostically robust and accurate.
Bert De Foer - One of the best experts on this subject based on the ideXlab platform.
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long term follow up after bony mastoid and epitympanic obliteration radiological findings
Journal of Laryngology and Otology, 2010Co-Authors: Jeanphilippe Vercruysse, Bert De Foer, Thomas Somers, Jan Casselman, Erwin OffeciersAbstract:Objective:The canal wall up bony obliteration technique lowers the incidence of recurrent Cholesteatoma, but carries the potential risk of obliterating residual Cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent Cholesteatoma. Patients: Fifty-one patients presenting with a Cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8-113.6 months). Intervention: All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging). Results: Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex Cholesteatoma. On high resolution Computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three Cholesteatomas, and differentiated them from other associated soft tissues. No Cholesteatoma was found within the obliterated mastoids. Conclusion: Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent Cholesteatoma and to reconstruct unstable Cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but Could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging Succeeded in differentiating soft tissues, enabling detection of residual or recurrent Cholesteatoma after a canal wall up bony obliteration technique procedure.
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detection of postoperative residual Cholesteatoma with non echo planar diffusion weighted magnetic resonance imaging
Otology & Neurotology, 2008Co-Authors: Bert De Foer, Jeanphilippe Vercruysse, Thomas Somers, Jan Casselman, A Bernaerts, F Deckers, Marc Pouillon, Erwin OffeciersAbstract:Objective The aim of this study was to analyze the role of non-echo-planar imaging (non-EPI)-based diffusion-weighted (DW) magnetic resonance imaging (MRI) for the detection of residual Cholesteatoma after canal wall-up mastoidectomy before eventual second-look surgery. Study design Prospective and blinded study. Setting Tertiary referral center. Patients The study group included the surgical, clinical, and imaging follow-up of 32 consecutive patients after primary Cholesteatoma surgery. Interventions All patients were investigated with MRI, including late postgadolinium T1-weighted sequence and non-EPI-DW sequence, 10 to 18 months after first-stage Cholesteatoma surgery by experienced surgeons using a canal wall-up mastoidectomy. The non-EPI-DW images were evaluated for the presence of a high-signal intensity lesion consistent with residual Cholesteatoma. Imaging findings were correlated with findings from second-stage surgery in 19 patients, clinical follow-up examination in 11 patients, and, in 2 patients, clinical and MRI follow-up examination. Results Non-EPI-DW sequences depicted 9 of 10 residual Cholesteatomas. The only lesion missed was a 2-mm Cholesteatoma in an examination degraded by motion artifacts in a child. All other diagnosed Cholesteatomas measured between 2 and 6 mm. Sensitivity, specificity, positive predictive value, and negative predictive value were 90, 100, 100, and 96%, respectively. Conclusion Except for motion artifact-degraded examinations, non-EPI-DW MRI is able to detect even very small residual Cholesteatoma after first-stage surgery by showing a high-signal intensity lesion. It has the capability of selecting patients for second-look surgery, avoiding unnecessary second-look surgery.
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the value of single shot turbo spin echo diffusion weighted mr imaging in the detection of middle ear Cholesteatoma
Neuroradiology, 2007Co-Authors: Bert De Foer, Jeanphilippe Vercruysse, Thomas Somers, Erwin Offeciers, A Bernaerts, Joachim Maes, F Deckers, Johan Michiels, Marc Pouillon, Jan CasselmanAbstract:Introduction Single-shot (SS) turbo spin-echo (TSE) diffusion-weighted (DW) magnetic resonance imaging (MRI) is a non echo-planar imaging (EPI) technique recently reported for the evaluation of middle ear Cholesteatoma. We prospectively evaluated a SS TSE DW sequence in detecting congenital or acquired middle ear Cholesteatoma and evaluated the size of middle ear Cholesteatoma detectable with this sequence. The aim of this study was not to differentiate between inflammatory tissue and Cholesteatoma using SS TSE DW imaging. Methods A group of 21 patients strongly suspected clinically and/or otoscopically of having a middle ear Cholesteatoma without any history of prior surgery were evaluated with late post-gadolinium MRI including this SS TSE DW sequence. Results A total of 21 middle ear Cholesteatomas (5 congenital and 16 acquired) were found at surgery with a size varying between 2 and 19 mm. Hyperintense signal on SS TSE DW imaging compatible with Cholesteatoma was found in 19 patients. One patient showed no hyperintensity due to autoevacuation of the Cholesteatoma sac into the external auditory canal. Another patient showed no hyperintensity because of motion artifacts. Conclusion This study shows the high sensitivity of this SS TSE DW sequence in detecting small middle ear Cholesteatomas, with a size limit as small as 2 mm.
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value of high resolution computed tomography and magnetic resonance imaging in the detection of residual Cholesteatomas in primary bony obliterated mastoids
American Journal of Otolaryngology, 2007Co-Authors: Bert De Foer, Jeanphilippe Vercruysse, Thomas Somers, Jan Casselman, Marc Pouillon, Erwin OffeciersAbstract:Purpose: The objective of this study was to assess the value of high-resolution computed tomography (HRCT) and that of magnetic resonance imaging (MRI), including postcontrast T1weighted images and echo-planar diffusion-weighted (EP-DW) images, in the detection of residual Cholesteatomas after primary bony obliteration of the mastoid. Patients and methods: Twenty-three patients underwent a second-look surgery 8 to 18 months after they underwent a primary bony obliteration technique. All patients were evaluated by HRCT and MRI before their second-look surgery. A retrospective analysis was performed. Results: A residual Cholesteatoma was found in 2 of the 23 patients; both cases of Cholesteatoma had a diameter less than 4 mm. In these 2 patients, residual Cholesteatoma was found in the middle ear cavity and not in the obliterated mastoid. In all cases, HRCT showed a homogeneous obliteration of the mastoid cavity. On MRI, only one Cholesteatoma pearl was detected using contrast-enhanced T1weighted imaging. Findings from the EP-DW imaging were negative for all cases. Conclusion: This study demonstrates that HRCT is still the imaging technique of choice for the evaluation of bony obliterated mastoids. It shows the low sensitivity and specificity of HRCT for the characterization of an associated opacified middle ear and those of contrast-enhanced T1weighted imaging and EP-DW imaging for the detection of small residual Cholesteatomas after primary bony obliteration. D 2007 Published by Elsevier Inc.