Cholesterol granulomas are rare noncancerous cysts that occur at the tip of the petrous apex, a part of the skull next to the middle ear. Granulomas can occur throughout the body and usually cause no symptoms or serious complications. However, cholesterol granulomas of the petrous apex, a bony structure located in the skull base, are dangerous due to their proximity to the ear and several important nerves.
Surgery is usually needed to drain, ventilate, or remove the cholesterol granuloma. Your surgical team will evaluate your condition and recommend the best surgical approach based on the location of your cyst and the status of your hearing.
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What Is Cholesterol Granuloma?
Cholesterol granulomas are rare, noncancerous cysts that occur at the tip of the petrous apex, a part of the skull that is next to the middle ear. Granulomas can occur throughout the body, and they usually have no symptoms or serious effects.
However, cholesterol granulomas of the petrous apex, the bony structure located in the skull base, are dangerous due to their proximity to the ear and several important nerves. Surgery is usually needed to drain, ventilate, or remove the cholesterol granuloma.
Is cholesterol granuloma a brain tumor?
No. A cholesterol granuloma is a type of cyst, not a tumor.
How common is cholesterol granuloma?
Cholesterol granulomas are rare, affecting fewer than one in a million people each year.
What causes cholesterol granuloma?
Cholesterol granulomas form when the air cells in the petrous apex are obstructed. The obstruction creates a vacuum that causes blood to be drawn into the air cells.
As red blood cells break down, cholesterol in the hemoglobin is released. The immune system reacts to the cholesterol as a foreign body, producing an inflammatory response.
Associated small blood vessels rupture as a result of the inflammation, causing recurrent hemorrhaging that makes the mass expand.
Cholesterol granuloma risk factors
You may be at increased risk for cholesterol granuloma if:
- You have a family history of hypercholesterolemia (high cholesterol).
- You have frequent middle ear infections.
Complications of cholesterol granuloma
If left untreated, and the mass continues to expand, cholesterol granulomas of the petrous apex can cause:
- Bone destruction.
- Nerve damage.
- Permanent hearing loss.
How can I prevent cholesterol granuloma?
There is nothing you can do to prevent cholesterol granuloma.
What Are the Signs and Symptoms of Cholesterol Granuloma?
Symptoms of cholesterol granuloma may include:
- Facial numbness.
- Facial twitching.
- Hearing loss in one ear.
- Seizures.
- Tinnitus (ringing in the ears).
- Vertigo.
- Vision problems.
When should I see a doctor about my cholesterol granuloma symptoms?
If you have symptoms of cholesterol granuloma, you should schedule an appointment with your doctor right away. Early treatment can reduce your risk of complications. If you have a seizure or severe symptoms, dial 911 or visit the nearest hospital Emergency Department.
How Do You Diagnose Cholesterol Granuloma?
To diagnose cholesterol granuloma, your doctor will ask about your symptoms. They'll do a physical and ear exam, and order imaging tests.
What to expect during your visit
To make the diagnosis of cholesterol granuloma, your doctor will examine your ear with an otoscope. The eardrum may appear blue, or your doctor may notice a brownish protrusion behind it.
Your doctor will also:
- Ask about your symptoms.
- Order imaging tests.
- Perform a physical exam.
- Review your health history and medications.
Tests to diagnose cholesterol granuloma
Your doctor may order imaging studies, including:
- CT scan — A test that uses a series of x-rays to create images of your body's organs, bones, and tissues.
- Magnetic resonance imaging (MRI) — A test that uses a magnetic field and radio waves to pinpoint where the tumor is and help doctors determine the size.
Your doctor may also perform an audiogram to assess hearing loss.
Cholesterol granuloma prognosis
Cholesterol granuloma can be effectively treated with surgery. Recurrence is rare after surgical treatment. You will need routine follow-up care to check for signs of recurrence.
How Do You Treat Cholesterol Granuloma?
Your doctor will evaluate your cholesterol granuloma and recommend a treatment plan based on:
- How quickly the mass is growing.
- The severity of your symptoms.
- The size of the mass.
Treatment options may include:
Monitoring
If your cholesterol granuloma is small, slow-growing, and isn’t causing symptoms, you may not need surgical treatment right away. Your doctor may recommend monitoring the mass over time to see if it grows.
Surgery for cholesterol granuloma
Surgical treatment typically involves drainage and ventilation of the cholesterol granuloma. In cases where the granuloma is particularly large and destructive, surgical removal may be necessary.
However, accessing the petrous apex is difficult and requires special surgical skills. Your surgeon will recommend the best approach based on the location of the mass and your current hearing status.
Endoscopic endonasal approach (EEA)
Your doctor may recommend the endoscopic endonasal approach (EEA) for cholesterol granulomas of the petrous apex. This state-of-the-art, minimally invasive approach allows your surgeon to access the tumor through the natural corridor of the nose, without making an open incision. Your surgeon will then remove the cholesterol granuloma through the nose and nasal cavities.
EEA surgery offers the benefits of no incisions, no disfigurement, and a faster recovery time. In addition to being minimally invasive, EEA also preserves hearing.
Other surgical approaches
Your doctor may treat the cholesterol granuloma through your ear canal or by making an incision behind your ear.
Why Choose UPMC for Cholesterol Granuloma Care?
When you choose UPMC for cholesterol granuloma care, you will receive:
- Access to world-class neurosurgery expertise — Our world-renowned experts treat the full spectrum of skull base and neurosurgical conditions using the latest diagnostic and treatment techniques.
- A full range of treatment options — We offer nonsurgical care and noninvasive, minimally invasive, and traditional open surgical procedures. This allows us to effectively treat all types of disorders while reducing your risk of complications.
- Multidisciplinary care — Our skull base surgeons partner with neurosurgeons, neurologists, rehabilitation specialists, and other medical experts to provide complete care that optimizes your recovery and quality of life.
