Large Cholesterol Granuloma of the Middle Ear Eroding into the Middle Cranial Fossa

BACKGROUND Cholesterol granuloma of the middle ear is extremely rare in comparison to cholesterol granuloma of the petrous apex but sometimes shows an aggressive course. CASE REPORT We report herein a case involving a large, aggressive cholesterol granuloma of the middle ear that eroded the middle cranial fossa. A 64-year-old woman presented with pain in the left ear and hearing loss. Cholesterol granuloma was finally diagnosed from diffusion-weighted imaging, and cortical mastoidectomy was performed with canal wall down tympanoplasty type III. Recovery was uneventful recovery and the patient well at the 3-year follow-up. CONCLUSION This case demonstrates the rare but clinically important pathology of aggressive cholesterol granuloma of the middle ear.