Learning Objectives:

Introduction: To prevent residual and recurrent cholesteatoma, we performed canal wall down technique with the obliteration of paratympanic spaces for patients with acquired cholesteatoma.

Material and Methods:  229 ears were operated (223 patients: 81 females and 142 males). In 158 cases an operation was performed for the first time and 71 cases were revision and re-operation after surgery by other surgeons. All patients underwent sanation surgery with the obliteration of paratympanic spaces followed by the restoration of the posterior wall of the external auditory meatus and simultaneous tympanoplasty (closed-type surgery). Close tympanic cavity with chondro-perichondrial flap with simultaneous ossicculoplasty. Obliterate paratympanic spaces with bone pate, or bioglass, or allocartilage and cover it with chondroperichodrial flap. The patients were examined one year after the treatment with the use of the MRI technology using the non-EPI DWI regime to monitor the residual and recurrence cholesteatoma.

Results: From 2009 to 2015, we operated 229 ears. The results were evaluated according to otomicroscopy, MRI sequences, such as the non-EPI DWI and recorded for survey. From 2009 to 2011 the residue of cholesteatoma was diagnosed in 3 cases (3,7%), from 2009 to 2012–7 cases (5.9%), from 2009 to 2013–9 cases (6%), from 2009 to 2014–11 cases (5,8%) and from 2009 to 2015–11 cases (4,8%). No residual cholesteatoma were detected in the obliterated mastoid cavity.

Conclusion: Long-term follow up indicated that the canal wall down technique with bony obliteration is a safe method with which to treat primary cases and to reconstruct unstable cavities. The MRI technology in the non-EPI DWI regime was successful in differentiating soft tissues and enabling the detection of residual or recurrent cholesteatoma after a canal wall down bony obliteration technique procedure.