The Use of Non-EPI DWI MRI Scanning in the Management of Cholesteatoma

Non-EPI DWI MRI scanning is now an established post-operative investigation in the management of patients treated for cholesteatoma with studies even reporting sensitivity and specificity of up to 100% [1-5]. Following the introduction of endoscopic tympanoplasty, the use of these scans pre-operatively has been adopted to determine the extent and location of cholesteatoma; this operative technique is suitable for cholesteatomas confined to the middle ear and attic without extension beyond the posterior limit of the lateral semi-circular canal. This less invasive technique to remove cholesteatoma has become even more important in the era of Covid-19 where the ability to wear adequate PPE whilst using the microscope and high -speed drills remains challenging. The role of these MRI scans to measure growth rate of cholesteatoma and whether all cholesteatomas require surgical removal should be considered. The technique, benefits and limitations of non-EPI DWI MRI scans in managing our patients pre-and post-operatively is discussed.