BACKGROUND: Cholesterol granulomas of the petrous apex may impinge surrounding cranial nerves, leading to neurological impairments such as hearing loss. Less invasive endoscopic techniques are gaining popularity as the mainstay of therapy for this lesion.

CASE REPORT: We present a case of petrous apex cholesterol granuloma causing mild sensorineural hearing loss. An endoscopic endonasal transsphenoidal approach was successfully performed to partially resect and aerate the lesion. The auditory function on the affected side was completely restored after surgery. The patient experienced no post-operative complications.

CONCLUSIONS: This case report highlights the advantages of using an endoscopic transsphenoidal surgical approach in cases of petrous apex cholesterol granuloma, including the potential for this less invasive technique to restore sensorineural hearing loss.

Keywords: case reports, Cholesterol, Hearing Loss, Neurosurgery, Recovery of Function, Skull Base, Granuloma, Foreign-Body, Hearing Loss, Sensorineural, Petrous Bone