The Role of Radiological Assessment in the Management of Chronic Cholesteatomatous Otitis Media: A Retrospective Study at Avicenna Military Hospital, Marrakech

Abstract: Objective: To assess the clinical utility of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in both the initial staging and the post-surgical follow-up of chronic cholesteatomatous otitis media (CCOM). Methods: Our team conducted a retrospective study of 51 patients treated at the Avicenna Military Hospital in Marrakech between 2020 and 2024. Preoperative high-resolution CT was the baseline for all cases. For surveillance and complex cases, MRI—specifically non-echo-planar diffusion-weighted imaging (non-EPI DWI)—was utilized. Results: The study population (mean age 40 years) showed a significant prevalence of bony destruction on preoperative CT, including scutum erosion (82.35%) and ossicular chain involvement (60.78%). Postoperatively, MRI was performed in 19 cases, accurately identifying 6 recurrences and 10 residual “pearls,” effectively distinguishing them from inflammatory granulation tissue. Conclusion: While CT remains the “roadmap” for surgical safety, non-EPI DWI MRI has become the cornerstone of postoperative monitoring. This dual-modality strategy has significantly reduced the need for invasive “second-look” surgeries in our department.