Optimal timing of radiological follow-up in detection of cholesteatoma recurrence
Reviewed by Richard (Wei Chern) Gan

This is a meta-analysis assessing the optimal timing of postoperative magnetic resonance imaging (MRI) for surveillance in detecting cholesteatoma recurrence. A systematic literature review of searches of articles between 2013 and 2024 in PubMed, Embase and Cochrane were conducted according to PRISMA guidelines. For studies with repeated MRIs, the probability of a negative MRI at each time point and derived complementary probability of a positive MRI were calculated. For studies with a single measurement, the probability of a positive MRI was calculated. Data were plotted on a smoothed curve with 95% confidence intervals. Meta-analysis was performed. Of the 525 studies identified, 16 met the inclusion criteria, comprising a total of 1187 patients. Primary MRI protocol was non-EPI DWI (83.33%) and EPI DWI in 3 (16.67%). Meta-analysis of positive MRI restricted to studies with standardised follow-up intervals (15 studies) showed positive MRI rates of 12% at 1 month, 19% at 6 months, 15% at 12 months, 22% at 24 months, 12% at 36 months, 21% at 48 months and 13% at 60 months. Patients who underwent canal wall up (CWU) procedures had higher positive MRI rates than canal wall up or canal wall down (CWD) with obliteration procedures. At 12 months, the proportion of positive MRIs among CWU patients was 22% compared to 7% among CWU/CWD with obliteration. This pattern persisted at 36 months (18% vs. 9%). Subgroup analysis showed rate of positive MRIs in paediatric patients (3 paediatric-only studies) was 20% at 12 months compared to adults (5 adult-only studies) at 16%. They propose the first postoperative non-EPI DWI MRI to be at 12 to 24 months. If the initial scan is negative, they propose follow-up imaging at 2-year intervals, thereafter, continued for at least 5 years.

Defining the Timing of Radiological Follow-Up for Detection of Cholesteatoma Recidivism: A Meta-analysis.
Wolfovitz A, Segal E, Murad H, et al.
OTOLARYNGOL HEAD NECK SURG 
2026;174(6):1410–20.