Internal Nasal Valve Expanding Graft for Middle Vault Reconstruction.

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre- and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P < 0.05). Based upon pre- and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P < 0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.

Endoscopic Repair of Persistent Oroantral Communications Using the Caldwell-Luc Approach.

In this article, a novel endoscopic technique used to close oro-antral fistulas will be described. In the technique described here, 24 cases were surgically treated between May 2011, and November 2014. Under endonasal endoscopic examination following partial inferior uncinectomy, the natural ostium of the maxillary sinus was identified; through this tract, a curved aspirator was advanced into the sinus. If present, we extracted endoscopically tissues causing obliteration of the ostium through the Caldwell-Luc antrostomy, taking care to preserve the integrity of the natural ostium. In the technique described here, endoscopic examination using the Caldwell-Luc approach, the inside of the maxillary sinus is explored fully, existing infection and polyps are eliminated locally, and natural patency of the maxillary sinus ostium can be achieved. The graft used to obliterate the oroantral fistula can be easily harvested from the bone of the anterior wall of the maxillary sinus by accessing the surgical entry tract.

Evaluation of the Olfactory Function With the "Sniffin' Sticks" Test After Endoscopic Transsphenoidal Pituitary Surgery.

The aim of this study was to evaluate the olfactory function of patients who had undergone endoscopic transsphenoidal pituitary surgery. In this prospective study, the "Sniffin' Sticks" test was performed between June 2016 and April 2017 at Izmir Katip Celebi University Ataturk Training and Research Hospital. Thirty patients who were scheduled to undergo endoscopic transsphenoidal pituitary surgery were evaluated preoperatively and 8 weeks postoperatively using the Sniffin' Sticks test battery for olfactory function, odor threshold, smell discrimination, and odor identification. The patients were evaluated preoperatively by an otolaryngologist. The patients' demographic data and olfactory functions were analyzed with a t test and Wilcoxon-labeled sequential test. The study group comprised 14 women (46.7%) and 16 men (53.3%) patients. The mean age of the patients was 37.50 ±â€Š9.43 years (range: 16-53 years). We found a significant difference in the preoperative and postoperative values of the odor recognition test (P = 0.017); however, there was no significant difference between the preoperative and postoperative odor threshold values (P = 0.172) and odor discrimination values (P = 0.624). The threshold discrimination identification test scores were not significant (P = 0.110). The olfactory function of patients who were normosmic preoperatively was not affected postoperatively. This study shows that the endoscopic transsphenoidal technique for pituitary surgery without nasal flap has no negative effect on the olfactory function.

Outcomes and Complications of Endoscopic Versus Microscopic Transsphenoidal Surgery in Pituitary Adenoma.

This retrospective study aimed to define outcomes and complications of endoscopic versus microscopic transsphenoidal surgery in pituitary adenoma. Data of 94 patients who underwent transsphenoidal endoscopic (n = 45) or microscopic surgery (n = 49) between June 2000 and June 2014 for pituitary adenoma, performed at Katip Çelebi University Hospital, were retrospectively analyzed. The patients' symptomatology, type of adenoma, radiologic findings, surgical outcomes, and preoperative and postoperative complications were investigated. The total subtotal resection rate was 73.4% (69 patients) and partial resection rate was 26.6% (25 patients). Total subtotal resection rate was 77.6% (38 patients) in the microscopic group and 68.9% (31 patients) in the endoscopic group. Total resection was seen more often in the endoscopic group than in the microscopic group, with no significant difference between the groups. Four patients (8.2%) in the microscopic group had postoperative cerebrospinal fluid leak compared with 3 patients (6.7%) in the endoscopic group. Two patients (2.1%) had hematoma, with 1 patient each in the endoscopic and microscopic group. Panhypopituitarism development rate was higher in the endoscopic group (no significant difference between the 2 groups). One patient (2%) developed blindness in the microscopic group and 1 (2.2%) had meningitis in the endoscopic group. Based on this study, the total resection rate was higher in the microscopic group than in the endoscopic group. However, outcomes and complication rate did not differ significantly between the 2 surgical techniques. Both techniques have advantages and disadvantages. Prospective randomized controlled trials should be conducted to compare the 2 surgical methods.

Prevertebral space invasion in head and neck cancer: negative predictive value of imaging techniques.

OBJECTIVE: This study evaluated the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in prevertebral space invasion in patients with head and neck squamous cell carcinomas (HNSCC). SUBJECTS AND METHODS: This study retrospectively reviewed 197 patients with advanced primary laryngeal or hypopharyngeal carcinoma who underwent laryngectomy and neck dissection at our institution. The MRI and CT findings were compared with the surgical findings and postoperative pathology. RESULTS: In 191 patients, the macro- and microscopic margins of the surgical specimens were tumor-free. In the remaining 6 patients, prevertebral space involvement was observed intraoperatively. MRI predicted the absence of prevertebral fascia invasion in 40 of 42 patients with a negative predictive value of 100% and specificity of 95.2%, while the negative predictive value and specificity of CT were 99.2% and 88.2%, respectively. CONCLUSION: Preservation of the retropharyngeal fat plane on MRI reliably predicts the absence of prevertebral space fixation in patients with advanced HNSCC.

Endoscopic endonasal transsphenoidal surgery for pituitary adenomas.

OBJECTIVE: The objective of this study was to report the efficacy, safety, and outcomes of endoscopic endonasal transsphenoidal techniques for pituitary adenomas. PATIENTS AND METHODS: A retrospective data analysis of 32 patients who underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma between February 2011 and December 2013 was performed. The patients' demographic data, clinical presentations, radiologic findings, recurrence rates, and complications were analyzed. RESULTS: There were 14 men and 18 women with age ranging from 23 to 74 years (mean age, 48.6 y). Functioning and nonfunctioning tumors were present in 22 (68.8%) and 10 patients (31.2%), respectively. Among the functioning adenomas, 8 patients (25%) had growth hormone-secreting adenomas, 6 patients (18.8%) had prolactinomas, 5 patients (15.6%) had adrenocorticotropic hormone-secreting adenomas, 2 patients (6.2%) had follicle-stimulating hormone/luteinizing hormone-secreting adenomas, and 1 patient (3.1%) had thyroid-stimulating hormone-secreting adenomas. Of the 32 patients, 20 (62.5%) had pituitary macroadenomas and 12 patients (37.5%) had microadenomas. Total-subtotal tumor resection was achieved in 75% and 45% of the microadenomas and macroadenomas, respectively. Radiologically, 60% of the macroadenomas had suprasellar and carvenous sinus extension. Postoperative cerebrospinal fluid leaks occurred in 3 patients. Two patients developed temporary diabetes insipidus. CONCLUSIONS: Endoscopic transsphenoidal surgery is an effective and safe treatment for most patients with pituitary adenoma and could be considered the first-choice therapy in these patients.

Osteoplastic flap approach versus orbitotomy in case of orbitofrontal cholesterol granuloma.

A 44-year-old man developed a slow-growing painless left superolateral orbital mass that extended into the frontal sinus with a complaint of ptosis. Magnetic resonance imaging revealed a heterogenous hyperintense lesion confined to the left frontal bone and superior orbit. The osteoplastic frontal sinus approach was performed to drain supraorbital cholesterol granuloma cyst and for curetting the capsule. Orbitofrontal cholesterol granuloma characteristically arises in the diploe of the superolateral frontal bone. The traditional approach for a primarily orbitofrontal cholesterol granuloma is the transorbital approach including anterior orbitotomy or lateral orbitotomy. However, the osteoplastic approach should be kept in mind as an alternative aprroach for the management of supraorbital lesions in patients with well-pneumatized frontal sinus.

Transection of Nasolacrimal Duct in Endoscopic Medial Maxillectomy: Implication on Epiphora.

OBJECTIVE: Management of the nasolacrimal system is usually recommended during medial maxillectomy via external approach because of reported higher rates of postoperative epiphora. Association of the endoscopic medial maxillectomy (EMM) with epiphora, however, is not clearly stated. In this study, we attempted to evaluate whether patients develop epiphora after simple transection of the nasolacrimal duct during EMM. PATIENTS AND METHODS: Medical records of 26 patients who underwent endoscopic tumor resection for inverted papilloma (IP) were retrospectively reviewed. Patients who underwent EMM with nasolacrimal canal transection were included and recalled for lacrimal system evaluation. Twelve patients were eligible for inclusion and fluorescein dye disappearance test (FDDT) was performed for each patient. Patient demographics, tumor data, surgical procedures, and follow-up time were recorded. RESULTS: Of the 12 patients included in the study, 6 underwent canine fossa transantral approach concurrently with EMM. The mean duration of follow-up was 21.1 months (range, 6-84 months). Eight patients were graded as 0, whereas 4 patients were graded as 1 according to FDDT. All test results were interpreted as negative for epiphora. All patients were completely symptom free of epiphora. CONCLUSIONS: Epiphora after EMM with nasolacrimal canal transection among patients with sinonasal tumors appears to be uncommon. Therefore, prophylactic concurrent management of nasolacrimal system including stenting, dacryocystorhinostomy (DCR), or postoperative lacrimal lavage are not mandatory for all patients.

Orbital apex syndrome as a sign of unsuspected breast carcinoma.

Breast cancer, the most common form of cancer among women, rarely metastasizes to the paranasal sinuses and skull base. The disease usually proceeds insidiously, remaining asymptomatic until ocular symptoms appear. Orbital involvement is frequently seen in metastatic disease of the paranasal sinuses and skull base, but orbital apex syndrome is rare. Early presentation with clinical features of acute ethmoiditis can delay the diagnosis of metastatic disease. Here, we report the case of a 43-year-old woman with breast cancer who presented with orbital apex syndrome secondary to the skull base and paranasal sinus metastasis.

Complications of tracheoesophageal puncture and speech valves: retrospective analysis of 47 patients.

OBJECTIVES: This study aims to evaluate the complications of tracheoesophageal puncture (TEP) for voice restoration and speech valves in patients undergoing total laryngectomy. PATIENTS AND METHODS: Between January 2006 and June 2011, 47 male patients (mean age 62.8±1.2 years; range 41 to 80 years) who underwent TEP and speech valve for voice restoration after total laryngectomy were retrospectively analyzed. Secondary TEP was performed and Provox indwelling voice prosthesis were inserted in all patients. Demographic, disease and treatment characteristics of patients were recorded. Complications related to TEP and speech valves, the management of complications and clinical conditions of complete closure of TEP were also recorded. RESULTS: Tracheoesophageal puncture and speech valve related complications were observed in 20 patients. The majority of complications were minor complications including granulation tissue formation (n=2, 4.2%), deglutition of prosthesis (n=6, 12.7%) and TEP enlargement/leakage around prosthesis (n=9, 19.1%). Major complications were observed in three patients. Two of them were life-threatening complications; a mediastinitis (n=1, 3.1%) and paraesophageal abscess (n=1, 3.1%), and both appeared in the first month of the postoperative period. The overall complication rate was 42.6% during mean follow-up of 15.3 months. Tracheoesophageal fistula enlargement (n=9, 19.1%) was the most common minor complication and the most common cause of complete closure of TEP in this study. CONCLUSION: Tracheoesophageal puncture for voice restoration is not an entirely innocent procedure without any complications. Patients should be monitored for TEP-related complications in the early and late postoperative period.

Endonasal endoscopic approach for recurrent nasolabial cyst.

Nasolabial cysts are rare nonodontogenic cystic lesions in the soft tissue of the midface and usually present with painless asymptomatic swelling in the nasolabial region. Surgical excision via sublabial approach is considered as the standard treatment. However, endonasal endoscopic marsupialization of the cyst is reported as an effective alternative method for nasolabial cysts. Marsupialization of the cyst is believed to integrate the nasolabial cyst into a part of the nasal cavity as an air-containing sinus. In this article, we present an endonasal endoscopic marsupialization technique in case of recurrent nasolabial cyst. To draw attention to this approach, we present our case with current literature.

[Approaches to antrochoanal polyps in adults: long-term comparative results]. / Eriskinlerde antrokoanal poliplere yaklasim: Uzun dönem karsilastirmali sonuçlar.

OBJECTIVES: This study aims to evaluate the long-term results of endoscopic sinus surgery and combined approach with Caldwell Luc procedure for the treatment of antrochoanal polyps. PATIENTS AND METHODS: Between January 2002 and December 2009, 41 patients (24 males, 17 females; mean age 34.7 years; range 14 to 78 years) were retrospectively analyzed. Patients were divided into two groups according to treatment modality: group 1 included 26 patients who underwent endoscopic sinus surgery alone and group 2 included 15 patients who underwent endoscopic sinus surgery in combination with Caldwell Luc procedure. Both groups were compared for recurrence and complication rate. RESULTS: Seventeen of 41 patients were diagnosed with right-sided lesions, while 24 patients had left-sided lesions. Recurrence was seen in three patients, including two were in the group 1 and one was in the group 2. There was no statistically significantly difference between the groups in terms of recurrence and complication rate (p>0.05). Mean follow-up was 50.5 months (range 15 to 94 months). CONCLUSION: Current approach for the treatment of antrochoanal polyps is endoscopic sinus surgery. However, combined approaches should be performed to avoid recurrences, unless removal of antral part of the antrochoanal polyp completely by endoscopic resection is possible. Selection of the combined techniques depends on the surgeon familiarity with the procedure and whether the patient is pediatric case. Combined approach with Caldwell Luc is a safe procedure in adults.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer.

INTRODUCTION: 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. OBJECTIVE: To investigate the prognostic value of these parameters in patients with head and neck cancers. METHODS: We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. RESULTS: The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63cm3 (0.6-34.3), 68.9g (2.58-524.5g), 13.89 (4.89-33.03g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. CONCLUSION: Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Application of Sal classification to parotid gland fine-needle aspiration cytology: 10-year retrospective analysis of 312 patients.

BACKGROUND: The accuracy of fine-needle aspiration biopsy (FNAB) is controversial in parotid tumors. We aimed to compare FNAB results with the final histopathological diagnosis and to apply the "Sal classification" to our data and discuss its results and its place in parotid gland cytology. METHODS: The FNAB cytological findings and final histological diagnosis were assessed retrospectively in 2 different scenarios based on the distribution of nondefinitive cytology, and we applied the Sal classification and determined malignancy rate, sensitivity, and specificity for each category. RESULTS: In 2 different scenarios FNAB sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 81%, 87%, 54.7%, and 96.1%; and 65.3%, 100%, 100%, and 96.1%, respectively. The malignancy rates and sensitivity and specificity were also calculated and discussed for each Sal category. CONCLUSION: We believe that the Sal classification has a great potential to be a useful tool in classification of parotid gland cytology.

Analysis of Recurrence after Frontolateral Laryngectomy.

OBJECTIVE: This study aimed to evaluate the recurrence and survival of patients treated with frontolateral laryngectomy for T1 and T2 glottic laryngeal carcinoma. METHODS: Patients who underwent frontolateral laryngectomy for glottic laryngeal carcinoma at a tertiary hospital between March 2009 and June 2014 were included. Patient demographics, tumor stage, treatment and histopathological examination data, and adjuvant therapy details were evaluated. RESULTS: Thirty patients with T1aN0, T1bN0, and T2N0 vocal fold carcinoma were examined. The mean follow-up duration was 40 months. Of the 30 patients, nine (30%) were stage T1 and 21 (70%) were in stage T2. Twenty-nine patients were males and one was female, and the mean age was 59 (range, 42-81) years. During follow-up, local recurrence was observed in four patients following frontolateral laryngectomy. Six patients continued smoking after frontolateral laryngectomy, of which three developed tumor recurrence. The local control rate was poor in patients with anterior commissure involvement (66.6%) compared with those with no involvement (95.2%). Two of four patients with local recurrence were treated with salvage total laryngectomy and adjuvant postoperative radiotherapy; the remaining two were treated with only radiotherapy. One patient who was treated with only radiotherapy developed lung metastasis during follow-up and died because of distant metastasis. CONCLUSION: Frontolateral laryngectomy is an efficient choice of treatment for selected cases of T1 and T2 glottic laryngeal carcinoma.

Is T-tube treatment effective in Meyer-Cotton grade 3 tracheal stenosis: long-term outcomes.

OBJECTIVES: To present retrospective experience in Meyer-Cotton grade 3 tracheal stenosis of 17 patients treated by T-tube, considering the characteristics of the treated stenosis, surgical procedures performed, and post-operative outcomes and complications. METHODS: All demographic and clinical data were collected retrospectively. Chest and neck computed tomography scans were performed to assess the stenosis, including length, location, and glottic involvement. The stenotic area was evaluated endoscopically according to an adapted Meyer and Cotton grading scale. RESULTS: The aetiology of the tracheal stenosis was intubation-related in all cases. The duration of intubation ranged between 1 hour to 40 days. According to the Myers-Cotton classification, all patients were at stage 3. Mean length of the stenosis was 26.58 ± 12.02 (range =15-70) mm. Mean follow-up for the study group was 60.16 ± 34.10 (range =18-137) months. Two patients died during follow-up, one due to stroke, one due to chronic lymphocytic leukemia; no deaths were attributable to TS. The remaining 15 patients could be evaluated up to the present time. Post-operative decannulation was achieved in three of 15 patients (20%), and decannulation was not achieved in 12 of 15 patients (80%). CONCLUSION: T-tube is not an effective treatment of tracheal stenosis.

Lymph Node Density in Node-Positive Laryngeal Carcinoma: Analysis of Prognostic Value for Survival.

OBJECTIVE: We investigated the value of lymph node density (LND) as a predictor of survival in patients with laryngeal squamous cell carcinoma (SCC) and positive neck node (pN+) after laryngectomy. STUDY DESIGN: Case series with chart review. SETTING: Katip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey. SUBJECTS AND METHODS: We reviewed the records of 289 patients with newly diagnosed primary laryngeal carcinomas who underwent partial or total laryngectomy and combined neck dissection at a tertiary referral center between June 2006 and December 2014. Patients with pN+ laryngeal SCC (n = 101) were included in the study. Overall survival (OS) and disease-free survival (DFS) were used to evaluate the prognostic significance of LND. RESULTS: In 101 patients with pN+ laryngeal SCC, LND ≥0.09 and number of metastatic lymph nodes >4 were significantly associated with OS and DFS but not the overall tumor, node, and metastasis stage. Forward stepwise Cox regression analysis revealed that LND ≥0.09 was the only independent predictor of both DFS and OS. Furthermore, the odds ratio of LND ≥0.09 was 10 times higher in patients with regional recurrence when compared patients without regional recurrence. CONCLUSIONS: LND was the only independent prognostic predictor of OS and DFS in patients with pN+ laryngeal SCC. Moreover, patients with LND ≥0.09 were significantly associated with high risk of regional recurrence. Thus, patients with LND ≥0.09 are at high risk of regional recurrence and death and may be considered for adjuvant chemoradiation.

Prognostic value of 18F-FDG PET/CT parameters and histopathologic variables in head and neck cancer / Valor prognóstico de parâmetros de PET/TC com 18F-FDG e variáveis histopatológicas em câncer de cabeça e pescoço

Abstract Introduction 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters such as; maximum standardized uptake values, standard metabolic tumor volume and otal lesion glycosis are important prognostic biomarkers in cancers. Objective To investigate the prognostic value of these parameters in patients with head and neck cancers. Methods We performed a retrospective study including 47 patients with head and neck cancer who underwent18F-fluorodeoxyglucose positron emission tomography/computed tomography prior to treatment. Standard metabolic tumor volume, otal lesion glycosis and standardized uptake were measured for each patient. The prognostic value of quantitative 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and clinicopathologic variables on disease free survival and overall survival were analyzed. Results The median (range) standard metabolic tumor volume and otal lesion glycosis and standardized uptake were 7.63 cm3 (0.6-34.3), 68.9 g (2.58-524.5 g), 13.89 (4.89-33.03 g/mL), respectively. Lymph node metastases and tumour differentiation were significant variables for disease free survival and overall survival, however, all 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters were not associated with disease- free survival and overall survival. Conclusion Pretreatment quantities positron emission tomography parameters did not predict survival in head and neck cancer.

Resumo Introdução Os parâmetros da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose, como os máximos valores de captação padronizados, o volume metabólico tumoral padrão e a glicólise total da lesão são importantes biomarcadores prognósticos de câncer. Objetivo Investigar o valor prognóstico desses parâmetros em pacientes com câncer de cabeça e pescoço. Método Fizemos um estudo retrospectivo que incluiu 47 pacientes com câncer de cabeça e pescoço e que foram submetidos à tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose antes do tratamento. Volume metabólico tumoral, glicólise total da lesão e valores de captação padronizados foram aferidos em cada paciente. O valor prognóstico de parâmetros quantitativos da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose e das variáveis clínico-patológicas sobre a sobrevida livre de doença e a sobrevida geral foi analisado. Resultados A média (intervalo) de volume metabólico tumoral e glicólise total da lesão e valores de captação padronizados foram 7,63 cm3 (0,6-34,3), 68,9 g (2,58-524,5) e 13,89 g/mL (4,89-33,03), respectivamente. Metástase nos nódulos linfáticos e diferenciação tumoral foram variáveis significativas de sobrevida livre de doença e sobrevida geral; contudo, nenhum parâmetro da tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose estava associado a sobrevida livre de doença e sobrevida geral. Conclusão As quantidades dos parâmetros da tomografia por emissão de pósitrons pré-tratamento não previram a sobrevida em câncer de cabeça e pescoço.

Value of Echo-Planar Diffusion-Weighted Magnetic Resonance Imaging for Detecting Tympanomastoid Cholesteatoma.

OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy of echo-planar diffusion-weighted magnetic resonance imaging (EP-DWI) and high-resolution computed tomography (HRCT) in the detection and localization of cholesteatoma. MATERIALS AND METHODS: Fifty-four patients were prospectively included in this study. Patients with suspected primary or residual cholesteatoma were evaluated by EP-DWI and HRCT before tympanomastoid surgery. Radiological findings were correlated with intraoperative findings. RESULTS: EP-DWI and HRCT accurately predicted the presence or absence of cholesteatoma in 49 of 54 (90.7%) and 37 of 54 (68.5%) patients, respectively. The sensitivity, specificity, and positive and negative predictive values of EP-DWI were 88.4%, 92.8%, 92%, and 89.6%, respectively. However, sensitivity, specificity, and positive and negative predictive values of HRCT were 69%, 67.8%, 66.6%, and 73.07%, respectively. CONCLUSION: This study demonstrates that EP-DWI is more reliable in predicting the presence and localization of cholesteatoma compared with HRCT, before tympanomastoid surgery.