Which investigation of choice confirms the diagnosis and extent of cholesteatoma when endoscopic findings are equivocal or to plan surgery?

• A High-resolution CT scan of temporal bones
• B Tympanometry
• C MRI with diffusion-weighted imaging (DWI/non-EPI DW-MRI) ✓
• D Auditory brainstem response

Explanation

Non-echo planar diffusion-weighted MRI (non-EPI DWI, e.g., HASTE or PROPELLER DWI) is the investigation of choice for cholesteatoma diagnosis and follow-up, as cholesteatoma demonstrates restricted diffusion (bright on DWI, dark on ADC) due to its keratin-rich content. It is particularly useful for detecting residual or recurrent disease after canal wall-up mastoidectomy without the need for second-look surgery. HRCT temporal bone is used for surgical planning (ossicular chain erosion, tegmen, sigmoid sinus dehiscence) but cannot reliably distinguish cholesteatoma from granulation tissue.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.