Invasive middle ear cholesterol granuloma involving the basal turn of the cochlea with profound sensorineural hearing loss

A retrospective surgical case review. A tertiary-care, university teaching hospital. The authors describe a unique case operated on for a middle ear cholesterol granuloma, which had invaded the cochlea and vestibule causing profound sensorineural deafness. Extended radical mastoidectomy and labyrinthectomy with musculofascial seal. Successful postoperative outcome with no recurrence seen after 2 years of follow up. To the authors' knowledge, this is the first reported case of a primary middle ear cholesterol granuloma with direct invasion into the cochlea. Such invasion of the otic capsule by cholesterol granulomas is rare and presents a diagnostic challenge to the attending otologist and radiologist. Salient points of the case history, pathogenesis, imaging studies, histopathology, and management are presented with a review of the current literature.