A 25-year-old man presents with a dull ache and fullness in the right ear. The tympanic membrane appears dark blue and bulging. Aspiration yields a dark brown viscous fluid containing glittering crystals that show birefringence under polarised light. The most likely diagnosis is:

• A Secretory otitis media
• B Glomus tympanicum tumour
• C High jugular bulb
• D Cholesterol granuloma ✓

Explanation

Cholesterol granuloma, also called idiopathic haemotympanum or chocolate ear, results from impaired ventilation of the middle ear causing negative pressure, haemorrhage, and breakdown of blood with deposition of cholesterol crystals that provoke a foreign body giant cell reaction. The blue drum and brown aspirate with birefringent cholesterol crystals are diagnostic. Secretory otitis media gives amber fluid without crystals, while glomus tumour and high jugular bulb produce a reddish vascular retrotympanic mass, not blue.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.