Nasoseptal Cholesterol Granuloma

Nasoseptal Cholesterol Granuloma: Understanding the Rare Disorder

Nasoseptal Cholesterol Granuloma is an inflammatory deposit usually found in the petrous apex and other pneumatized areas of temporal bone. The temporal bones are present at the base and sides of the skull and overlaid by the sides of the head known as “temples”. Cholesterol granuloma rarely occurs in the nose, but according to ear nose throat doctors, there are some extremely rare cases of the presence of cholesterol granuloma in the nasal septum. Let’s delve deeper to understand the characteristics and treatment of the medical problem.

The Cause of Nasoseptal Cholesterol Granuloma

Cholesterol granuloma has a core of cholesterol crystal and chronic inflammation, surrounded by a foreign body giant cell. There are two hypothesis used to find the causes of Cholesterol granuloma includes exposed marrow hypothesis and obstruction-vacuum theory.

Obstruction-vacuum Theory

The obstruction vacuum theory explains the development of cholesterol granuloma of the paranasal sinus and petrous apex. According to the theory, the mucosal swelling in the area leads to air trapping and ventilation obstruction. This causes a negative pressure that causes extravasation of blood and transudate.

Exposed Marrow Hypothesis

According to this hypothesis – when air cells develop, they might erode the vascular marrow filled in cavities, which might cause subacute hemorrhage. The negative pressure generated because of the hemorrhage might result in extravasation of transudate and blood.

Symptoms, Diagnosis and Treatment

The clinical symptoms in any of the cases of cholesterol granuloma are non-specific, as there could be different appearances on the basis of the location and extent of lesions. Dr. Kuperan, along with a team of other doctors, in a recently published research paper, revealed that no characteristic radiographic findings were visible in cases of nasoseptal cholesterol granuloma. The correct diagnosis either depends on characteristic histologic finding or can be assessed through surgery. As far as the treatment is concerned, rhinologists recommend surgical removal of the granuloma.

Last Few Words

Cholesterol granuloma was initially thought to be a response to hypoventilation because of mucosal swelling and occlusion of air cells. These were, however, reported usually in the petrous apex area. Dr. Kuperan and the team of doctors have already handled nasoseptal cholesterol granulomas. Should you wish to learn more about this rare disease or have any questions, you may get in touch with Dr. Kuperan at Houston Advanced Nose and Sinus, or fill out our contact form and we will take it from there.

(Image credit: Creative Commons)

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