Keratosis obturans is a condition characterized by a keratotic mass of dead skin in the ear canal, often affecting individuals aged 5 to 20. Symptoms include severe ear pain, hearing loss, and a distinctive keratin plug, with potential associations to bronchiectasis and sinusitis. Treatment involves removing the keratin debris and managing inflammation, though recurrence is common.

1. Keratosis obturans
• Keratotic mass of desquamated epithelium in bony
portion of EAC obstructing it
• Pearly white / obscured by wax
• Common age : 5 -20 yrs
• Etiology
– Idiopathic
– Chronic hyperemia  desquamation of keratin 
epidermal debris
– Faulty migration of squamous epithelial cells
– May be associated with bronchiectasis & sinusitis

2. Clinical Features
• Severe pain in the ear with aural fullness
– Bilateral symptoms in children
– Unilateral predominantly in adults
• Hearing loss (conductive) , otorrhea (rare),
tinnitus
• Geometrically patterned keratin plug within
the lumen of expanded ear canal (onion skin)
• Erosion and abnormal widening of deep
osseous meatus (eburnated bony canal ,
ballooning of EAC)
• TM usually intact
• Mucopurulent discharge (rare)

3. Treatment
• Removal of the Keratotic debris by
instrumentation (LA /GA)
• Treatment of inflammation
• Keratolytic - not helpful
• Canalplasty (recurrent cases)
• Regular follow – up , May recur!!