Tympanomastoid cholesterol Granulomas presenting as a Blue Eardrum in children

Abstract

Objective(s): This clinical study was performed to analyze the characteristics of cholesterol granuloma (CG) and evaluate our results in children.

Methods: The clinical records of children diagnosed with CG were retrospectively reviewed.

Results: The total of 17 children (20 ears) with CGs were included in this study. Endoscopy revealed pars flaccida retractions and lipoid tissue deposition behind the intact blue tympanic membrane (TM). CT scan revealed bony erosion and extensive soft tissue in the middle ear and mastoid. No ossicular chain destruction was found. All 20 ears underwent canal wall-up mastoidectomy and ventilation tube (VT) insertion, 3 sets of VT were performed in 5 ear and 2 sets in one. The residual perforation was seen in 2 ears following VT. The CT revealed well-pneumatized antra and tympanic cavities at postoperative 12-24 months.

Conclusion(s): The CG should be suspected for the patients with yellow lipoid deposition behind the blue TM. CT of CG usually revealed bony erosion and extensive soft tissue in the middle ear and mastoid. Mastoidectomy combined with VT insertion and etiological treatment have a favorable prognosis for CG in children.

Keywords: Cholesterol granuloma; Eustachian tube dysfunction; Mastoidectomy; Otitis media with effusion; Ventilation tube.

Fig. 1

A-12 year-old boy. Endoscopic examination showed an right OME at first visit hospital, however, first treatment was refused (A), right OME with blue eardrums and lipoid tissue deposition of tympanic cavity (white arrows) at second visit hospital,time interval from the first visit was 9 months (B),and postoperative 7 months (C)

Fig. 2

The preoperative CT revealled soft tissue density in the tympanic cavity, antrum, and aditus ad antrum (A), postoperative CT revealled well pneumatolytic middle ear (B,C, and D).Please note, this is the same patient as in Fig. 1

Fig. 3

A-8 year-old boy. Endoscopic examination showed an right intact blue eardrums and yellow granulation tissue of tympanic cavity (white arrows) (A), CT revealed the bilateral soft tissue density in the antrum, aditus ad antrum and mastoid (B)

Fig. 4

Intraoperative yellow cholesterol crystal (A), the cholesterol crystal with inflammatory granulation tissue was comfirmed by the histological examination (B), and postoperative 9 months (C).Please note, this is the same patient as in Fig. 3 The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/vPTIxl