Cholesterol Granuloma Development following Temporal Bone Surgery.

Objective: To describe the clinical presentation and management of patients with cholesterol granulomas (CGs) that develop following temporal bone surgery.
Study Design: Case series with chart review.
Setting: Two independent tertiary academic referral centers.
Subjects and Methods: A multicenter retrospective review was performed to identify all patients between 2001 and 2014 who were diagnosed with a CG that developed following temporal bone surgery. Patients with a history of idiopathic petrous apex CGs were excluded, as were those with <6 months of follow-up after diagnosis. Demographic and clinical data were recorded at presentation, and the main outcome measure was symptom evolution over time.
Results: A total of 20 patients met inclusion criteria (median age, 55.0 years; 70.0% female), and their cases were analyzed. Diagnosis was made, on average, 149.5 months (median, 94.5; range, 13.0-480.0) following a temporal bone operation, which was for chronic ear disease in 75.0% of cases. The most common presenting symptoms were otalgia (55.0%) and otorrhea (40.0%). In patients initially managed with observation, 71.4% required no surgical intervention through a mean of 56.8 months (median, 30; range, 12.0-178.0) of follow-up. For those who initially underwent surgical excision, durable symptom relief was achieved in 66.7% of cases.
Conclusion: Postoperative CG formation in the temporal bone is a rare occurrence that can be encountered years following surgery. The present study suggests that conservative management can be appropriate for many cases in which patients are relatively asymptomatic.
(© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.)