Objective: To investigate the etiology and pathogenesis of cholesteatoma otitis media accompanied by cholesterol granuloma and the relationship between cholesteatoma and cholesterol granuloma.
Methods: Sixty three cases of middle ear cholesterol granuloma treated in our hospital during the period from March 1988 to May 2000 were retrospectively reviewed. All cases were verified by surgery and pathology. Fifteen cases of cholesteatoma coexisted with cholesterol granuloma were found among the 63 patients.
Results: All fifteen cases had a long-term history of otitis media, such as otorrhea (sanguine purulent otorrhea and bloody otorrhea in 8 cases) and perforation of the ear drum (perforation of pars flaccida in 8 cases). Temporal bone CT scans showed cholesteatoma in 11 cases. All patients were treated surgically, and cholesteatoma and cholesterol granuloma were found coexisting alternatively, and the latter lied mainly in the tympanic antrum, attic and mastoid air cells. Chocolate-colored mucus was accumulated in well-developed mastoid air cells, and glistening dotty cholesterol crystals were also found. In most cases, enlarged aditus, destruction of lateral attic wall, erosion of ossicular chain, exposition of horizontal segment of facial nerve and tegmen of attic were found. Occlusion of Eustachian tube was found in 6 cases, and occlusion of tympanic isthmus was found in all cases. A post-operative dry ear was obtained, and hearing improved in all 12 cases following tympanoplasty.
Conclusions: Cholesteatoma and cholesteatoma granuloma in middle ear may share a common pathophysiological etiology, an occlusion of ventilation and a disturbance of drainage. The diagnosis should be considered when patients with chronic otitis media presented with bloody otorrhea. CT and magnetic resonance imaging(MRI) are useful for the diagnosis before operation. The surgical approach depends on the location, extension and severity of the lesion, and the principle of surgery is to clear the lesion and create an adequate drainage.