Keratosis obturans is a very painful condition of the ear. It is caused due to excessive accumulation of the keratin debris in the bony external canal probably due to faulty migration of the epithelium. This presentation aims to explain the definition, etiology, clinical features and treatment of keratosis obturans.

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!!