Cholesterol granulomas of the middle ear (CGME) constitute a focal inflammatory response with foreign body giant cells mobilized against the presence of cholesterol crystals. The air spaces within the temporal bone are commonly affected, especially in association with chronic disease of the middle ear involving diminished ventilation. The aim of this paper is to review 5 cases of CGME. The authors intend to establish the etiology of CGME and its likely relationship with other common middle ear diseases.