Correlation between MRI findings and second-look operation in cholesteatoma surgery

Two-staged intact canal wall tympanoplasty is a common operation for treatm ent of middle ear cholesteatoma. MRI provides better tissue differentiation of the middle ear and/or mastoid, which often become occupied with soft de nsity tissue after the first operation. If MRI was able to detect the prese nce of a recurrent or residual cholesteatoma with sufficient sensitivity an d specificity, this may facilitate a decrease in the number of second-look procedures. This study compared MRI findings to surgical findings at second -look surgery and calculated the correlation rates between the two sets of findings, Thirty ears having undergone intact canal wall tympanoplasty for cholesteatoma at the initial operation were examined by MRI prior to the se cond look. Otoscopic findings of the tympanic membrane were nonsuspect in a ll cases. The true positive rate was 11/30 (37%) and the true negative rate was 10/30 (33%), leading to a radiosurgical correlation of 70%, whereas th e false positive rate was 6/30 (20%) and the false negative rate was 3/30 ( 10%). This indicates that 30% of the MRI findings were incorrect. Therefore , at the present time, MRI does not appear as a likely replacement for seco nd-look surgery in cases of intact canal wall tympanoplasty. Copyright (C) 2001 S. Karger AG, Basel.