Cholesterol Granuloma

Cholesterol granuloma is an inflammatory lesion most commonly found in the central skull base. This lesion typically forms when blood from bone marrow leaks into a nearby air cell. The trapped blood eventually breaks down and generates significant inflammation, resulting in a buildup of fluid in the air cell. This fluid-filled lesion slowly expands over time and causes progressive thinning of surrounding bone.

Central growth may result in compression and irritation of the fifth and sixth cranial nerves, resulting in facial numbness or pain, or double vision. Lateral growth with erosion of the inner ear or internal auditory canal may result in hearing loss, dizziness, or facial nerve symptoms (twitching or weakness).

Evaluation

At UT Southwestern Medical Center, your physician will do a physical examination and look at your ears with an otoscope. The eardrum might appear blue or have a visible brown protrusion behind it. Your doctor will assess any hearing loss and may also perform magnetic resonance imaging (MRI) or computerized tomography (CT) scans of the head to look for the lesions.

Treatment Options

Asymptomatic lesions can be followed with serial MRI or CT scans. Symptomatic cholesterol granulomas can be managed by surgical drainage either through the nose or ear, depending on your anatomy. Surgical excision of the lesion is occasionally required if adequate drainage cannot be established.