الفهرس 
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Abstract
Cholesteatoma arises from squamous epithelium in the middle ear or mastoid cavity which erodes the structures of the middle and inner ear and has a high rate of recurrence. The diagnosis of cholesteatoma is based on clinical findings, in which otoscopy and otomicroscopy play a major role. However, a cholesteatoma may not always be apparent on examination and may be obscured by a polyp or granulation tissue.
Pre-operative radiological studies are accepted as standard in many otological centers for better understanding of the anatomy and pathological changes of the middle ear and the mastoid cavity. High resolution Computed tomography (HRCT) is still the most sensitive method in detecting middle ear cholesteatoma extensions but it has poor specificity and it cannot differentiate between various types of opacification and has poor sensitivity. This is the reason that otologists seek alternative imaging modalities for better evaluation of the various types of pathological diseases that may be present in the ear.
The aim of the work is to propose a staging system of tympanomastoid cholesteatoma using clinical and radiological findings.
The study design is prospective descriptive study which includes fifty patients presenting with chronic suppurative otitis media, attending the outpatient clinic of the Otolaryngology- Head & Neck Surgery Department, Alexandria Main University Hospital (tertiary referral center) during the period from October 2012 to October 2015.
All patients in the study were subjected to history taking, physical examination, audiological and radiological assessment (HRCT and DW MRI).
In the present study, HRCT and Non-EPI DW MRI was used in clinically proven patients of cholesteatoma and compared with the intra-operative findings (a gold weighted standard parameter).
The study included 50 patients; 29 were males (58%) and 21 were females (42%). The mean age was 37.7 years with standard deviation of 14.25 years in the range of 3-62 years old.
The present study showed good correlation between the size of cholesteatoma pre-operatively using DW images and its size at the time of surgery. The smallest cholesteatoma detected pre-operatively measured about 3 mm intra-operatively. DW images successfully depicted cholesteatoma measuring between 3 and 10 mm. However we found that lesions measuring less than 3 mm can be missed as shown by NPV of only 40 percent. However, we were not able to propose a new staging system for cholesteatoma using MRI.