Isil CAKMAK KARAER, Nina JOCHER, Wolfram SANTER, Thomas LINDER
The Journal of International Advanced Otology - 2026;22(5):1-4
Cholesterol granulomas (CG) are benign, expansile lesions that arise from a foreign body giant cell reaction to cholesterol crystals, surrounded by chronic inflammation and fibrous tissue. In this case report, a patient reported a sudden onset of symptoms, presented with twice positive beta-trace protein (BTP) samples from his middle ear fluid, and due to watery otorrhea, a cerebrospinal fluid (CSF) leak was initially suspected. Even though the intrathecal contrast-enhanced myelography turned out negative, 2 unsuccessful surgical attempts to localize the leak finally led to the correct diagnosis of a BTP-positive cholesterol granuloma with cyst formations. As cases with CG do not produce beta-2 transferrin, both markers should be tested to confirm CSF leakage before proceeding to surgical intervention in case of doubt.
