My Cholesterol Granuloma Experience: The Diagnosis

This ordeal lasted over 2 months, first originating around Thanksgiving weekend. I felt normal at the time, except for one small thing… I started noticing a “whooshing” heartbeat in my left ear. It was reasonably subtle in the beginning, but became consistent enough to where I was prompted to make an appointment with my general doctor. After briefly researching the subject, I learned that the proper term to this heartbeat sound was “pulsatile tinnitus.” Going into the appointment, I was convinced that the problem was mostly due to earwax, and my doctor was agreeing as well. We tried to flush out the ear without any real results, which is when the doctor saw what appeared to be black “cerumen” impacted against my ear drum. Since the flushing didn’t work, she recommended I see a Head & Neck specialist, or ENT, where they would have more tools to remove this black earwax.

No problem, I made another appointment with the ENT about a week later. In the meantime, I bought the same exact WaterPik flushing tool my general doctor had used, and tried flushing my ear at home. After a few attempts myself, I gave up and decided to just wait for the ENT doctor to handle it. My pulsatile tinnitus wasn’t letting up, and was progressively getting worse. When it came time to see the ENT, I walked in with high-spirits thinking it’d be a quick job, just pluck out this ear wax and I’ll be on my way… Unfortunately things would not be so easy. This ENT Doctor, who I’ll call Doctor K, examined my left ear and immediately asked the question, “why do you have blood in your ear?” I had no answer. What was thought to be black cerumen was certainly no longer the case. In fact, it wasn’t in my ear canal at all – it was BEHIND my ear drum, which was causing the entire membrane to look black (the more analytically correct description would be “blue”, which is why I initially had so much difficulty finding anything under “black ear drum”). Doctor K suggested looking at my Eustachian Tube to see if it was opened properly, which meant numbing my nose and shoving an endoscope up it. My left Eustachian Tube appeared fine, but an unyielding amount of questions remained. The top 2 candidates were: Hemotympanum (bleeding in the tympanic cavity of the middle ear, but from what?) or a Glomus Tumor. I was prescribed steroids and pseudophedrine to help treat the former.

As I sat in the Pharmacy, waiting over half an hour for 2 simple prescriptions to be sorted (it wasn’t even busy that day), I Googled on my phone about this “Glomus Tumor.” I remember reading a site which outlined the prominent symptom to be “pulsatile tinnitus,” and with surgery being the treatment option. I wanted my ear problem to be Hemotympanum, I could make up excuses for myself for the potential causes. Maybe too much stress caused a small vein to burst in my ear? Sure, sounds good. But the longer I searched on my phone, the more likely the possibility of a Tumor seemed to be. I felt numb. The Pharmacy around me was swimming. To accentuate the situation, when I finally got out of that Pharmacy and drove back to work, the pulsatile tinnitus was going off like drums in my ear. When I did get back to work, I sat emotionless and empty behind my desk. This was supposed to be a smooth day, the day I would get my earwax unclogged, pulsatile tinnitus eliminated – and also the day my BMW 135i would be delivered. Taking the car out for a spin when I eventually got home didn’t feel as pleasurable as I hoped it would be, with the news of my ear drowning my mood. Instead, that day was the day I felt utter dread. When you’re living a seemingly normal life, it’s hard to handle getting suddenly turned upside down with the possibilities of tumors and surgery.

I took the medication with no results. My pulsatile tinnitus was growing worse and much more constant. I started to lose sleep because of how loud the noise got in my left ear at night. During the day I had periods of relief, but whenever that noise came back I felt despair. I’d lose concentration – listening to it pulsate and pulsate relentlessly. One of the worst part of this whole experience was the psychological damage caused by that damned tinnitus. You can really endear and appreciate silence after going through something like this.

2 weeks passed so I made another appointment with Doctor K. He checked my ear and almost too excitedly announced, “Yup, it’s still black.” Next step, a CAT (CT) Scan. Doctor K was able to schedule me in for one on the same day. I arrived at the CT Scan location an hour early, so I sat idly in the waiting room, trying to fathom the gravity that my situation had become. I ultimately sat and waited for over 2 hours before they got me in, since there were a few higher priority patients ahead of me. Once I did finally get placed inside the machine to get scanned, I hear the technician say, “Oops! We have to pull you out.” Another emergency patient was coming in, so I was pushed aside and had to wait another 30 minutes. My actual scan only took about 10-15 minutes. I also had Contrast Dye intravenously injected (which makes your whole body feel flush and warm).

Doctor K was kind enough to call me back later that day and leave a voicemail regarding the results of the CT Scan, noting that although there was some sort of mass filling my middle ear, it was likely not a Glomus Tumor since the contrast did not enhance it. I could finally take a breath, thinking it might just be blood again.

After about another week, I went back to the Hospital to have an Audiogram done. The results showed a mild conductive hearing loss in my left ear, but this was always “normal” to me. Ever since I could remember, my left ear’s hearing was never as good as my right’s. I went through many ear infections as a child, which I suspected to be the cause of my hearing loss. I then saw Doctor K again and a colleague of his briefly checked out my ear, who thought it was interesting then left. Doctor K showed me the CT Scan and told me it was likely that I had a Glomus Tumor. After thinking WTF?! to myself, I rebutted with my recent recollection of being told this was NOT a Tumor, and did not enhance with contrast. I also wondered how a tumor could be so big, since my entire tympanic membrane was filled black. I was told I needed to get an MRI to know more information. Doctor K noted that tympanomastoidectomy would be the treatment for this tumor, and I asked for an elaboration. One thing you should know about Doctor K, he can be a very straight-shooter in his line of work. If you’ve seen the movie 50/50, he reminded me of the Doctor in the film who talks to the protagonist in a nonchalant, unaffectionate manner. Basically, Doctor K proceeds to robotically list out the procedure: which involves cutting into the head from behind the ear, lifting the ear drum, DRILLING into the mastoid bone, possible hearing bone damage, possible facial nerve damage with permanent paralysis, etc. I know being a Doctor and Surgeon requires a level of desensitization with the work, but this shouldn’t be so coolly reflected upon patients who are suffering. I wouldn’t want to get a stone-faced treatment when getting told bad news about my car, let alone about myself and my HEALTH.

At this point I was starting to lose my patience. I’ve been to the hospital repeatedly over the past month and all my appointments with Doctor K have lasted no longer than 15 minutes. I wasn’t satisfied with this Glomus Tumor being my fate, I wanted some more effort to be put into my case instead of flip-flopping. I went home and did more research myself, where I later discovered that a Cholesterol Granuloma could also be a possibility. I emailed Doctor K this suggestion and he agreed.

It was now Christmas vacation, and I went in for the MRI… which is a whole different animal to a CT Scan. A CT Scan is easy, you just lay inside a giant donut for a few minutes and you’re out. With an MRI, you get strapped down with a thermoplastic mask over your face. The scan time is also much longer, mine lasted about 45 minutes since I needed another contrast injection. An MRI is also super loud, my ears were starting to hurt by the end of it. While getting placed onto the table, I asked a technician if my MRI would have both T1 and T2 weighted scans. He thought I was showing off, but a distinctive characteristic of Cholesterol Granuloma is hyper-intensity on BOTH T1 and T2 images, which I wanted to make sure of myself.

As I’d later find out, the mass in my ear did indeed show up bright on both.