The positive pressure of cholesterol granuloma idiopathic blue eardrum. differential diagnosis.

The purpose of this presentation is to demonstrate the positive middle ear pressure in cholesterol granuloma, the so-called idiopathic blue drum or chocolate ear. Because of this positive middle ear pressure the patients with idiopathic blue eardrum do not tend to develop the retraction pockets or subsequent cholesteatoma and therefore this is rarely a destructive disease. Since the symptoms are minimal and there is no destruction, probably the best treatment of the idiopathic blue eardrum is no treatment at all. In cholesterol granuloma, chronic secretory otitis media, and chronic serous mastoiditis the results of surgery are dubious because the entire air cell system of the temporal bone, including the petrous apex, cannot be completely exenterated and therefore these cells continue to secrete and exert the positive pressure. Dubious surgical results in patients with positive pressure of cholesterol granuloma are illustrated by cases with open cavities and incomplete mastoid surgery, intact canal wall techniques with complete surgery and ablation, extensive radical mastoid surgery with closure of the canal and retention blue domed cysts forming in the cavities of modified radical, and fenestrations of the horizontal semicircular canal.