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Head and Neck
Diagnosis
Temporal Bone
Middle Ear-Mastoid
Infectious and Inflammatory Lesions
Middle Ear Cholesterol Granuloma
Middle Ear Cholesterol Granuloma
Bronwyn E. Hamilton, MD; H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Cholesterol granuloma (CG)

            • Synonyms

              • Cholesterol cyst, chocolate cyst, blue-dome cyst

            • Definitions

              • Recurrent hemorrhage into middle ear (ME) cavity causes inflammatory mass of granulation tissue

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Angeletti D et al: Tympanic cholesterol granuloma and exclusive endoscopic approach. Am J Case Rep. 21:e925369, 2020
                                          2. Hodges J et al: Gradenigo's syndrome and bacterial meningitis in a patient with a petrous apex cholesterol granuloma. Case Rep Infect Dis. 2020:8822053, 2020
                                          3. Kim SG et al: A case of fungal ball with cholesterol granuloma in the middle ear cavity. J Audiol Otol. 24(4):210-23, 2020
                                          4. Pace A et al: Tympano-mastoid cholesterol granuloma: case report and review of the literature. Clin Med Insights Case Rep. 13:1179547620958728, 2020
                                          5. Campion T et al: Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology. 61(9):959-70, 2019
                                          6. Khant ZA et al: Three-dimensional reversed fast imaging with steady-state precession diffusion-weighted imaging for the detection of middle ear cholesteatoma. Clin Radiol. 74(11):898.e7-13, 2019
                                          7. Laora AD et al: Cochlear implant electrode migration due to cholesterol granuloma: cues from a case. J Int Adv Otol. 15(3):466-8, 2019
                                          8. Bruchhage KL et al: Transsphenoidal and infralabyrinthine approach of the petrous apex cholesterol granuloma. Eur Arch Otorhinolaryngol. 274(7):2749-56, 2017
                                          9. Grinblat G et al: Petrous apex cholesterol granulomas: outcomes, complications, and hearing results from surgical and wait-and-scan management. Otol Neurotol. 38(10):e476-e485, 2017
                                          10. Kuruma T et al: Large cholesterol granuloma of the middle ear eroding into the middle cranial fossa. Case Rep Otolaryngol. 2017:4793786, 2017
                                          11. Olcott C et al: A blue middle ear mass: cholesterol granuloma mimicking a glomus tumor and endolymphatic sac tumor. Am J Otolaryngol. 38(1):100-2, 2017
                                          12. Özgen B et al: Accuracy of turbo spin-echo diffusion-weighted imaging signal intensity measurements for the diagnosis of cholesteatoma. Diagn Interv Radiol. 23(4):300-6, 2017
                                          13. Dinh CT et al: Atypical radiographic features of skull base cholesterol granuloma. Eur Arch Otorhinolaryngol. 273(6):1425-31, 2016
                                          14. Iannella G et al: Tympanomastoid cholesterol granuloma: radiological and intraoperative findings of blood source connection. Eur Arch Otorhinolaryngol. 273(9):2395-401, 2016
                                          15. Isaacson B et al: Endoscopic management of middle ear and temporal bone lesions. Otolaryngol Clin North Am. 49(5):1205-14, 2016
                                          16. Sweeney AD et al: Cholesterol granuloma development following temporal bone surgery. Otolaryngol Head Neck Surg. 154(6):1115-20, 2016
                                          17. Yawn RJ et al: Spontaneous resolution of a petrous apex cholesterol granuloma. Am J Otolaryngol. 37(5):452-4, 2016
                                          18. Polo R et al: Mastoid cholesterol granuloma with posterior cranial fossa compression. Otol Neurotol. 34(7):e103-4, 2013
                                          19. Shih TY et al: Erosive cholesterol granuloma. Otol Neurotol. 34(4):e26-7, 2013
                                          20. Ursick JA et al: Cholesterol granuloma. Ear Nose Throat J. 91(10):E31, 2012
                                          21. Matsuda Y et al: Analysis of surgical treatment for middle-ear cholesterol granuloma. J Laryngol Otol Suppl. (31):90-6, 2009
                                          22. Martin TP et al: A large and uncharacteristically aggressive cholesterol granuloma of the middle ear. J Laryngol Otol. 119(12):1001-3, 2005
                                          23. Murugasu E et al: Invasive middle ear cholesterol granuloma involving the basal turn of the cochlea with profound sensorineural hearing loss. Otol Neurotol. 25(3):231-5, 2004
                                          24. Jackler RK et al: A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol. 24(1):96-106; discussion 106, 2003
                                          25. Maeta M et al: Surgical intervention in middle-ear cholesterol granuloma. J Laryngol Otol. 117(5):344-8, 2003
                                          26. Friedmann I et al: The ultrastructure of cholesterol granuloma of the middle ear: an electron microscope study. The Journal of Laryngology and Otology, 1979; Vol. 93, pp. 433-442. J Laryngol Otol. 116(11):877-81, 2002
                                          27. Kosling S et al: CT and MR imaging after middle ear surgery. Eur J Radiol. 40(2):113-8, 2001
                                          28. Campos A et al: Cholesterol granuloma of the middle ear: report of 5 cases. Acta Otorhinolaryngol Belg. 50(2):125-9, 1996
                                          29. Martin N et al: Cholesterol granulomas of the middle ear cavities: MR imaging. Radiology. 172(2):521-5, 1989
                                          30. Palva T et al: Large cholesterol granuloma cysts in the mastoid. Clinical and histopathologic findings. Arch Otolaryngol. 111(12):786-91, 1985
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Clinical Issues

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Cholesterol granuloma (CG)

                                                    • Synonyms

                                                      • Cholesterol cyst, chocolate cyst, blue-dome cyst

                                                    • Definitions

                                                      • Recurrent hemorrhage into middle ear (ME) cavity causes inflammatory mass of granulation tissue

                                                    IMAGING

                                                    • General Features

                                                      • CT Findings

                                                        • MR Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Angeletti D et al: Tympanic cholesterol granuloma and exclusive endoscopic approach. Am J Case Rep. 21:e925369, 2020
                                                                                  2. Hodges J et al: Gradenigo's syndrome and bacterial meningitis in a patient with a petrous apex cholesterol granuloma. Case Rep Infect Dis. 2020:8822053, 2020
                                                                                  3. Kim SG et al: A case of fungal ball with cholesterol granuloma in the middle ear cavity. J Audiol Otol. 24(4):210-23, 2020
                                                                                  4. Pace A et al: Tympano-mastoid cholesterol granuloma: case report and review of the literature. Clin Med Insights Case Rep. 13:1179547620958728, 2020
                                                                                  5. Campion T et al: Imaging of temporal bone inflammations in children: a pictorial review. Neuroradiology. 61(9):959-70, 2019
                                                                                  6. Khant ZA et al: Three-dimensional reversed fast imaging with steady-state precession diffusion-weighted imaging for the detection of middle ear cholesteatoma. Clin Radiol. 74(11):898.e7-13, 2019
                                                                                  7. Laora AD et al: Cochlear implant electrode migration due to cholesterol granuloma: cues from a case. J Int Adv Otol. 15(3):466-8, 2019
                                                                                  8. Bruchhage KL et al: Transsphenoidal and infralabyrinthine approach of the petrous apex cholesterol granuloma. Eur Arch Otorhinolaryngol. 274(7):2749-56, 2017
                                                                                  9. Grinblat G et al: Petrous apex cholesterol granulomas: outcomes, complications, and hearing results from surgical and wait-and-scan management. Otol Neurotol. 38(10):e476-e485, 2017
                                                                                  10. Kuruma T et al: Large cholesterol granuloma of the middle ear eroding into the middle cranial fossa. Case Rep Otolaryngol. 2017:4793786, 2017
                                                                                  11. Olcott C et al: A blue middle ear mass: cholesterol granuloma mimicking a glomus tumor and endolymphatic sac tumor. Am J Otolaryngol. 38(1):100-2, 2017
                                                                                  12. Özgen B et al: Accuracy of turbo spin-echo diffusion-weighted imaging signal intensity measurements for the diagnosis of cholesteatoma. Diagn Interv Radiol. 23(4):300-6, 2017
                                                                                  13. Dinh CT et al: Atypical radiographic features of skull base cholesterol granuloma. Eur Arch Otorhinolaryngol. 273(6):1425-31, 2016
                                                                                  14. Iannella G et al: Tympanomastoid cholesterol granuloma: radiological and intraoperative findings of blood source connection. Eur Arch Otorhinolaryngol. 273(9):2395-401, 2016
                                                                                  15. Isaacson B et al: Endoscopic management of middle ear and temporal bone lesions. Otolaryngol Clin North Am. 49(5):1205-14, 2016
                                                                                  16. Sweeney AD et al: Cholesterol granuloma development following temporal bone surgery. Otolaryngol Head Neck Surg. 154(6):1115-20, 2016
                                                                                  17. Yawn RJ et al: Spontaneous resolution of a petrous apex cholesterol granuloma. Am J Otolaryngol. 37(5):452-4, 2016
                                                                                  18. Polo R et al: Mastoid cholesterol granuloma with posterior cranial fossa compression. Otol Neurotol. 34(7):e103-4, 2013
                                                                                  19. Shih TY et al: Erosive cholesterol granuloma. Otol Neurotol. 34(4):e26-7, 2013
                                                                                  20. Ursick JA et al: Cholesterol granuloma. Ear Nose Throat J. 91(10):E31, 2012
                                                                                  21. Matsuda Y et al: Analysis of surgical treatment for middle-ear cholesterol granuloma. J Laryngol Otol Suppl. (31):90-6, 2009
                                                                                  22. Martin TP et al: A large and uncharacteristically aggressive cholesterol granuloma of the middle ear. J Laryngol Otol. 119(12):1001-3, 2005
                                                                                  23. Murugasu E et al: Invasive middle ear cholesterol granuloma involving the basal turn of the cochlea with profound sensorineural hearing loss. Otol Neurotol. 25(3):231-5, 2004
                                                                                  24. Jackler RK et al: A new theory to explain the genesis of petrous apex cholesterol granuloma. Otol Neurotol. 24(1):96-106; discussion 106, 2003
                                                                                  25. Maeta M et al: Surgical intervention in middle-ear cholesterol granuloma. J Laryngol Otol. 117(5):344-8, 2003
                                                                                  26. Friedmann I et al: The ultrastructure of cholesterol granuloma of the middle ear: an electron microscope study. The Journal of Laryngology and Otology, 1979; Vol. 93, pp. 433-442. J Laryngol Otol. 116(11):877-81, 2002
                                                                                  27. Kosling S et al: CT and MR imaging after middle ear surgery. Eur J Radiol. 40(2):113-8, 2001
                                                                                  28. Campos A et al: Cholesterol granuloma of the middle ear: report of 5 cases. Acta Otorhinolaryngol Belg. 50(2):125-9, 1996
                                                                                  29. Martin N et al: Cholesterol granulomas of the middle ear cavities: MR imaging. Radiology. 172(2):521-5, 1989
                                                                                  30. Palva T et al: Large cholesterol granuloma cysts in the mastoid. Clinical and histopathologic findings. Arch Otolaryngol. 111(12):786-91, 1985