Keratosis Obturans- ENT

1. KERATOSIS
OBTURANS
SRIDHAR L
ROLL NO : 4094
1

2. DEFINITION
• Accumulation of desquamated keratin
in the external auditory meatus.
2

3. PATHOLOGY
• The keratin squames are shed from the complete
circumference of the deep ear canal forming a lamina.
• Geometrically patterned keratin plug within the lumen of
expanded ear canal.
• Normally the epithelium from the tympanic membrane
migrates to the posterior meatal wall.
• Failure of this migration or obstruction to the migration
by wax/foreign body causes keratosis. 3

4. SILENT TYPE
• There is no predisposing acute
infections involved.
• Caused by abnormal separation of
keratin.
• Persists even after removal. 4

5. INFLAMMATORY TYPE
• Due to acute inflammation of the ear
canal.
PATHOLOGY
• Causes increased epithelial turn over.
• Alteration of epithelial migration. 5

6. PRIMARY CHOLESTEATOMA
OF EAM
• Primarily there is an irregularity/erosion of the
bony wall – Post-traumatic or Post surgical.
• Squamous epithelium invades the bone.
• C/F – PAIN , Purulent Otorrhea , No CHL.
• Subjected to histopathology to r/o carcinoma,
necrotizing otitis externa etc. 6

7. 7

8. CLINICAL FEATURES
• 1. Severe ear pain.
• 2. Mild to Moderate conductive hearing
loss.
• 3. Associated bronchiectasis / sinusitis
/primary ciliary dyskinesia are common.
•
• 4. Rarely otorrhoea. 8

9. EXAMINATION
• The canal is occluded by a plug of white
keratin debris which contains a small amount
of normal appearing brown cerumen in its
centre.
• There may be accompanying granulations and
widening of external auditory canal
• CT images of temporal bone will show
widening of external canal with bone erosion. 9

10. 10

11. MANAGEMENT
• Treat the cause- impacted wax-syringing
inflammatory type- treat the infection.
foreign body- instrumentation.
• Use of keratolytic agents like 2% salicylic acid in alcohol.
• Surgical removal under General Anaesthesia.
• Canal plasty in recurrent cases.
• Mastoidectomy in patients with primary cholesteatoma
of external canal.
• Removed specimen should be sent for Histopathology
to rule out malignancy.
11

12. REFERENCES
• K B Bhargava , 9th edition, Sept 2011 , page no. 38, ‘Diseases of
external ear ‘
12

13. THANK YOU
13