Cholesterol granulomas are rare inflammatory deposits that can be located corporally, but are classically found in the petrous apex and other pneumatized areas of the temporal bone. Originally thought to be a response to hypoventilation due to mucosal swelling and occlusion of air cells, the pathogenesis of cholesterol granulomas recently has come under speculation. This is partly due to new theories of the importance of a rich blood supply in the lesion's development. Cholesterol granulomas have been reported in uncommon areas of the head and neck, such as surrounding the endolymphatic sac and pterygoid process of the sphenoid sinus.1 This entity has been described within the paranasal sinuses, including the maxillary, ethmoid, sphenoid, and frontal sinus locations. To our knowledge, we report the first case of a nasoseptal cholesterol granuloma.