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.
