[Excluding a recurrence of cholesteatoma using high resolution computerized tomography. Can one dispense with the second-look operation?].

In a prospective study 20 patients were examined by high-resolution computed tomography of the temporal bone (HR-CT) before an early or late second-look operation. One year earlier 8 of the patients had undergone a posterior tympanotomy ("intact canal wall" technique) for a cholesteatoma and if necessary a one-stage ossicular reconstruction. In 4 other patients a two-stage ossicular reconstruction was carried out. In the remaining 8 patients a one stage operation had been carried out several years before. After a cholesteatoma operation three typical X-ray findings can be observed in HR-CT: 1. Normal findings (no granulation tissue in the middle ear space, antrum or mastoid) 2. Granulation tissue without destruction 3. Cholesteatoma recurrence (homogeneous soft tissue mass with bony destruction) Based on previous experience we forego an early second-look 1 year later and suggest the following plan: 1. Providing the post-operative follow up proves normal, a HR-CT examination is carried out 2 years, after a cholesteatoma operation. 1.1 If the HR-CT, the clinical and audiological examinations are normal a HR-CT investigation is necessary a further 2 years later. 1.2 In the case of granulation tissue a further HR-CT must be carried out 1 year later. Should the granulations become progressively worse a second-look is mandatory. 1.3 Homogeneous soft tissue mass and destruction are signs of cholesteatoma recurrence. Immediate operation is necessary. 2. If audiological or clinical findings suggest a recurrent cholesteatoma within the first 2 years after the operation, HR-CT should be carried out at once.(ABSTRACT TRUNCATED AT 250 WORDS)