A cholesterol granuloma grows on the skull next to the middle ear and can cause serious symptoms such as hearing loss, vision difficulties, nerve damage, and seizures.

Cholesterol granulomas are fluid-filled cysts. They aren’t cancerous, but they often grow and get more severe with time. This condition is very rare, and its cause isn’t fully understood.

Treatment can completely resolve cholesterol granulomas and generally involves surgery to drain the cyst.

A cholesterol granuloma is a benign noncancerous cyst that forms on the skull next to the middle ear. This part of the skull is called the petrous apex.

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Cholesterol granulomas are very rare. They contain fluids, cholesterol‌ crystals, and lipids and expand over time.

Although cholesterol granulomas are noncancerous, they can be harmful. As they grow, they cause damage to the ear and push on surrounding nerves.

Cholesterol granulomas don’t always cause symptoms when they first appear. When symptoms do appear, they’ll be related to the exact size and exact location of the cyst.

Symptoms can increase and become more severe as the cholesterol granuloma continues to grow.

Symptoms of cholesterol granulomas include:

As the cholesterol granuloma grows, the damage can be permanent. This can lead to symptoms such as hearing loss or nerve damage becoming long-term complications. Treatment can help avoid these complications.

It’s not completely clear what causes cholesterol granulomas. It’s believed that they might form an inflammatory response to cholesterol.

When the air cells in your skull become obstructed, it can create a vacuum that draws in and destroys red blood cells. The destruction of red blood cells released cholesterol.

Your body then produces an inflammatory response to the cholesterol. The inflammation causes surrounding blood vessels to rupture. The rupture of blood vessels causes the area to expand and grow.

However, this theory hasn’t been fully proven. Some newer research contradicts this and suggests that the destruction of bone marrow might be responsible for cholesterol granulomas. More studies on this topic are needed.

There are a few known risk factors for cholesterol granulomas. They seem to be more common in families with familial hypercholesterolemia, but a link hasn’t been proven. They’re also seen more often in people with frequent middle ear infections.

Cholesterol granulomas are normally found after a medical appointment discussing your symptoms and medical history with a doctor.

You’ll have a physical exam, and your doctor will order tests to help make a diagnosis.

Imaging tests such as CT scans and MRI tests are generally the most important tests used to confirm a cholesterol granuloma. Imaging helps doctors identify the granuloma and helps to distinguish it from other cysts and lesions that can grow in the same area, such as:

These lesions can sometimes appear similar to cholesterol granulomas in unclear images. This can make diagnosis difficult. Your doctor might order an additional set of imaging tests to ensure a correct diagnosis.

Treatment depends on the size of the granuloma, how fast it is growing, and the severity of any symptoms it is causing.

Sometimes, cholesterol granulomas are small, slow-growing, and don’t cause symptoms. In this case, no immediate treatment is needed. The cholesterol granuloma will be noted in medical records and monitored, but no treatments will be done.

Surgery is done for granulomas that are causing symptoms or that are growing quickly. The exact surgical route will depend on the exact size and location of the cholesterol granuloma. Surgeons might access the granuloma through the nose or through the ear.

Either way, the granuloma will be drained, and a small plastic tube will be placed to ensure it does not reform.

The surgery completely resolves the cholesterol granuloma in nearly all cases. You’ll likely have multiple follow-up appointments to take images and make sure the granuloma hasn’t reformed. However, a second surgery is rarely required.

Additional treatment might be needed for any symptoms or complications or complications of cholesterol granulomas. This will be specific to the individual and the symptom.

For example, you might be prescribed a nonsteroidal anti-inflammatory drug (NSAID) pain relieving medication to help manage ear pain, facial pain, and headaches while you wait for cholesterol granuloma treatment surgery.

If the cholesterol granuloma causes nerve damage, you might be prescribed an anticonvulsant or antidepressant medication to manage your symptoms. You and your doctor can discuss the most appropriate options for you.

A cholesterol granuloma is a rare and noncancerous growth on the skull, next to the middle ear. The growths are cysts that are filled with lipids, fluids, and cholesterol crystals.

Although cholesterol granulomas aren’t cancerous, they can cause a range of serious symptoms, especially as they expand and grow larger. Symptoms can be severe and can include hearing loss, visual disturbances, and seizures.

Surgical treatment to drain the cholesterol granuloma can resolve the condition and prevent complications.