Recurrent cholesteatoma after mastoid and epitympanic obliteration: a descriptive CT and clinical study of 14 patients

Abstract

Background: Mastoid and epitympanic obliteration has become a widely used technique in cholesteatoma surgery to reduce postoperative recurrence. However, recurrent disease still occurs in some patients, and the anatomical sites and mechanisms of recurrence after obliteration remain insufficiently documented.Aims/objectives: To investigate the location of recurrent cholesteatoma using radiological and intraoperative findings and to assess its association with the quality of mastoid and epitympanic obliteration performed during surgery.Material and methods: A retrospective single-center study including 14 patients who underwent surgery for recurrent cholesteatoma from January 2016 to January 2025. All patients had obliteration performed during the initial surgery (canal wall up or down technique) using various materials, mainly S53P4 bioactive glass. Analysis was based on clinical records, CT scans, non–echo-planar diffusion-weighted MRI, and surgical findings.Results: Fourteen patients experienced recurrence after obliteration. All preoperative CT scans showed incomplete obliteration of the epitympanum. Recurrent disease mostly involved the epitympanum (86%), often extending to the mesotympanum or mastoid.Conclusions and significance: Cholesteatoma recurrence after obliteration appears to be associated with incomplete obliteration, particularly of the epitympanum. Complete obliteration, especially of anatomically challenging areas such as the supratubal recess, may play a key role in reducing the risk of recurrence.