The clinical presentation and the MRI features in a patient with a history of surgery for cholesteatoma of the left ear (pathologically proven) is most consistent with a recurrent cholesteatoma.

MRI with DWI is recommended in all patients with suspected cholesteatoma as well as on follow-up in patients with previous surgery for cholesteatoma for differentiating residual or recurrent cholesteatoma from granulation or inflammatory tissues which can be detected with great accuracy, whereas appearances on CT can be non-specific.