Cholesterol Granuloma

Cholesterol Granuloma

5 Cholesterol Granuloma

Keywords: cholesterol granuloma, hemosiderin, temporal bone drainage


In case of a cholesterol granuloma of the temporal bone, the tympanic membrane could appear bluish in color due to hemosiderin crystals in the middle ear. Cholesterol granuloma is thought to arise from obstructed drainage and insufficient aeration of cellular compartments of the temporal bone. Surgical treatment with mastoidectomy is usually performed, even though in the initial phases it may be sufficient to insert a ventilation tube.

Cholesterol granuloma is a histologic term used to describe a foreign body, giant cell reaction to cholesterol crystals, and hemosiderin derived from ruptured erythrocytes. Cholesterol granuloma is thought to arise from obstructed drainage and insufficient aeration of cellular compartments of the temporal bone. This leads to reabsorption of air, negative pressure, mucosal edema, and hemorrhage. It can be present in the middle ear, mastoid, or petrous apex. Generally, patients with tympanomastoid cholesterol granuloma have a long history of recurrent otitis media or otitis media with effusion. They also complain of conductive hearing loss, and on otoscopy the tympanic membrane appears bluish in color. In some cases, where granulation tissue is more prevalent, cholesterol granuloma can present as a retrotympanic reddish-brown mass that may cause bulging of the tympanic membrane, thus mimicking a glomus tumor. In these cases, a computed tomography (CT) scan is sufficient to clear up any doubts. A cholesterol granuloma rarely causes bone erosion. On the contrary, bone erosion is characteristic of glomus tumors causing destruction of the jugular hypotympanic septum with an irregular “moth-eaten” contour.

Hemotympanum is a different condition due to the presence of blood in the tympanic cavity. The most common causes include head trauma with or without skull base fracture, nasal packing, epistaxis, or clotting disorders.

In the initial phases, before cholesterol granuloma is formed, it might be sufficient to insert a ventilation tube, thus preventing further development of the granuloma. When the granuloma has already formed, it is necessary to perform a tympanoplasty with mastoidectomy that opens the intercellular septa, with subsequent aeration of the middle ear and mastoid.

Refer to the figures presented in this chapter ( ▶ Fig. 5.1, ▶ Fig. 5.2, ▶ Fig. 5.3, ▶ Fig. 5.4, ▶ Fig. 5.5, ▶ Fig. 5.6, ▶ Fig. 5.7, ▶ Fig. 5.8, ▶ Fig. 5.9, ▶ Fig. 5.10, ▶ Fig. 5.11, ▶ Fig. 5.12, ▶ Fig. 5.13, ▶ Fig. 5.14, ▶ Fig. 5.15, ▶ Fig. 5.16, ▶ Fig. 5.17, ▶ Fig. 5.18).


Fig. 5.1 Right ear. Typical blue tympanum caused by cholesterol granuloma. The blue color is due to hemosiderin crystals. The granuloma not only involves the middle ear but also generally extends into the mastoid air cells.


Fig. 5.2 Blue tympanum caused by cholesterol granuloma. An epitympanic retraction due to Eustachian tube dysfunction is also present.

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Apr 23, 2018 | Posted by in OTOLARYNGOLOGY | Comments Off on Cholesterol Granuloma

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