Monitoring

Patients are followed up in the ear, nose, and throat clinic to monitor for symptoms of cholesteatoma recurrence. During otoscopy, the cavity is examined for signs of a keratinous ear discharge. The mastoid cavity is often dry and may initially require wax removal in an aural care clinic.

A canal wall up mastoidectomy necessitates a second-look procedure at 9 to 12 months to examine for residual/recurrent disease. Alternatively, a non-echo-planar imaging diffusion-weighted MRI may be used in some patients.[28][29] There continues to be debate regarding which type of MRI is best to examine for recurrent cholesteatoma. Some authors advocate routine MRI scans (such as non-echo-planar, fast-spin echo, or diffusion weighted sequences) for follow-up, but caution that a negative scan may not be completely accurate as residual or recurrent disease may not yet be detectable. Non-echo-planar imaging was found to be more reliable compared with echo-planar imaging in identifying residual/recurrent cholesteatoma in one systematic review.[46] Patients will require continued follow-up.[47][48][49]

A canal wall down procedure may allow examination of the cavity for recurrence, but if the attic has been reconstructed a second-look procedure or a non-echo-planar imaging diffusion-weighted MRI may be necessary to examine the middle ear for recurrent disease.

Some cavities persistently discharge despite topical medical therapy. This may be treated with revision mastoid surgery or, if the cavity discharges despite multiple procedures, the cavity may be obliterated.[59] Topical mitomycin has been found to be more effective than chemical cautery (with topical acetic acid) in achieving a dry cavity.[60]​​

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