Keratosis obturans

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S[2]

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Keratosis obturans

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Overview

Keratosis obturans is accumulation of desquamated keratin in the external auditory meatus. It is common in young patient population.

Pathophysiology

Keratosis obturans is thought to occur due to abnormal epithelial migration of ear canal skin. The movement of the surface epithelium appears to be reversed in these patients. These keratin squames are shed from the complete circumference of the deep ear canal forming a lamina. It appears like onion skin. There exists 3 types of Keratosis obturans depending upon the pathology. They are:

  • Inflammatory type - it may be caused due to viral infection
  • Silent type - it is caused by abnormal separation of the keratin of the ears
  • Primary auditory canal cholesteatoma - it is caused by trauma to the external ear canal. Hearing impairment is not found in this type of keratosis obturans.

Risk Factors

Diagnosis

History and Symptoms

CT

  • CT scan of temporal bones may reveal canal erosion and widening.[1]

Other Diagnostic Studies

  • Surgical specimen after surgery should be sent for pathology testing to rule out malignancy.

Treatment

Surgery

  • Surgical removal is the main stay of treatment
  • Canal plasty - in case of recurrence
  • Mastoidectomy - in the primary auditory canal cholesteatoma type

References

  1. McCoul ED, Hanson MB (December 2011). "External auditory canal cholesteatoma and keratosis obturans: the role of imaging in preventing facial nerve injury". Ear Nose Throat J 90 (12): E1–7. PMID 22180115.

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