Question: A 72 year old male presents for conductive hearing loss. Examination reveals a dark blue-appearing, pulsatile tympanic membrane. The patient notes that he had undergone a mastoidectomy for a CSF leak years prior. MRI reveals a lesion that fills the mastoid and middle ear without connection to the middle cranial fossa that is bright on FLAIR imaging. What is the most likely diagnosis?

a) Cholesteatoma

b) Cholesterol granuloma

c) Effusion

d) Adenoma

[Answer will be posted with next week's new question]

Answer to last week's question, “Topical Conversation” (September 21, 2020)

A - Local transposition flap.