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Keratosis Obturans
By Michael Fung, University of Dundee, Dundee, Scotland
What is it?
Keratosis obturans is a rare condition. It is the accumulation of obstructing desquamated keratin in the external auditory meatus, with no associated erosion or necrosis of the surrounding bone.
Etiology
- No definitive cause has been established. However, the condition is thought to be caused by chronic hyperemia that increases desquamation of keratin and the ensuing formation of epidermal debris.
- Other theories as to the cause include broncheotracheosinusitis, which causes a sympathetic nervous system reflex in the cerumen glands which caused the hyperemia and keratin plugs to develop.
- It has also been suggested that a fault in the auditory epithelium migration is responsible for the accumulation of the squamous debris. The abnormal migration may be due to a viral triggered inflammation of the basal epithelial cells, it is these cells which are believed to be programmed for migratory activity.
Signs & Symptoms
- Conventionally bilateral symptoms (more frequent in childhood cases, whereas unilateral disease occurs predominately in adults)
- Younger age group (less than 40)
- Acute severe pain
- Conductive hearing loss
- Rarely otorrhea
- Thickened tympanic membrane due to pressure of the keratin
- Presence of granulations
- Ballooning of the ear canal (bony reabsorption circumferentially widens the external bony canal)
- On histological examination, the keratin plug displays a lamellar pattern. This pattern is due to the circumferential shedding of keratin squames from the auditory canal, with older layers being pushed centrally.
- The condition is related to eczema, seborrheic dermatitis and/or furunculosis and associated with sinusitis and/or bronchiectasis
Treatment
- Debridement of keratin debris (may require anesthesia)
- Treatment of any underlying inflammation and/or infection
- Periodical follow-up to remove reaccumulations
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