Keratosis obturans

Keratosis Obturans is a rare ear condition characterized by the accumulation of compacted keratin in the external auditory canal. This buildup leads to the blockage of the canal, causing significant discomfort and potential hearing loss. Unlike cerumen impaction, which involves the accumulation of ear wax, keratosis obturans involves the buildup of keratin, a protein that is a key component of skin, hair, and nails.

Etiology

The exact cause of keratosis obturans is not well understood. However, it is believed to be associated with abnormal epithelial migration of the ear canal skin. This condition is often seen in individuals with chronic inflammatory conditions of the ear, such as chronic otitis media and eczema. There is also a suggested link to systemic diseases, but further research is needed to understand the underlying mechanisms.

Symptoms

Patients with keratosis obturans typically present with severe ear pain, hearing loss, and sometimes, a discharge from the affected ear. The pain is often sudden in onset and can be accompanied by a sensation of fullness or pressure in the ear. In severe cases, the condition can lead to the widening of the external auditory canal due to the pressure exerted by the keratin plug.

Diagnosis

Diagnosis of keratosis obturans involves a thorough clinical examination, including a detailed history and physical examination of the ear. Otoscopy can reveal the presence of a dense, white plug within the external auditory canal. Imaging studies, such as CT scans, may be necessary to assess the extent of the condition and to rule out other causes of ear canal obstruction, such as osteomas or exostoses.

Treatment

Treatment of keratosis obturans focuses on the removal of the keratin plug and addressing any underlying conditions. This is typically done through careful cleaning and debridement by an ear, nose, and throat (ENT) specialist. In some cases, topical treatments or ear drops containing steroids or antibiotics may be prescribed to reduce inflammation and prevent infection. Surgery may be required in severe cases to widen the ear canal and prevent recurrence.

Prevention

Preventive measures for keratosis obturans include maintaining good ear hygiene and avoiding the insertion of objects into the ear, which can disrupt the natural process of epithelial migration and keratin removal. Individuals with chronic ear conditions should seek regular medical care to manage their symptoms and reduce the risk of developing keratosis obturans.

See Also

• Otitis Externa
• Earwax
• Cholesteatoma

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