Aim: Cholesterol granulomas are usually cystic lesions that commonly appear in the pneumatized petrous apex as a result of foreign body giant cell reaction to cholesterol crystals. The present study reports a case of a 38-year-old woman with petrous apex cholesterol granuloma who presented with a 10-year history of left-sided hearing loss of sudden onset and tinnitus.
Material and Method: The patient did not have headache, vertigo, or otalgia. The history was negative regarding medical problems, surgical procedures, and otologic diseases.
Results: Examination revealed unilateral sensorineural hearing loss and the patient complained of tinnitus and trigeminal neuralgia. MRI scan revealed a bright mass in both T1 and T2 sequences suggesting the diagnosis of cholesterol granuloma excluding congenital cholesteatoma. After careful evaluation of the patient and detailed discussion with her, it was decided to follow conservative management with serial scanning.
Conclusion: The clinical manifestations of cholesterol granulomas depend on their anatomic location and the involvement of the adjacent structures. Clinical and radiologic follow-up was preferred in this case of a nonaggressive lesion. ENT surgeons should be aware of cholesterol granulomas and their differential diagnosis usually based on the MRI findings and plan management according to age, hearing, growth, and other individual factors.
