Sakit Telinga : KERATOSIS OBTURANS

Keadaan selepas pembedahan







































Ni mende dikeluarkan.






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