A 25-year-old woman presents with fullness and mild conductive hearing loss in one ear without discharge. Otoscopy shows a dark blue, bulging tympanic membrane. Aspiration yields a dark brown, viscous 'chocolate-coloured' fluid. The most likely diagnosis is:

• A Congenital cholesteatoma
• B High jugular bulb with dehiscence
• C Glomus tympanicum tumour
• D Cholesterol granuloma (idiopathic haemotympanum) ✓

Explanation

Cholesterol granuloma, historically called idiopathic haemotympanum, arises from impaired ventilation of the middle ear causing repeated microhaemorrhages, breakdown of red cells and deposition of cholesterol crystals with foreign body giant cell reaction. It classically gives a blue drum and chocolate-coloured aspirate. A glomus tumour shows a reddish blush that blanches with positive pressure (Brown sign), while a high jugular bulb is a venous anomaly without aspirable fluid.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.