Keratosis obturans: Description, Causes and Risk Factors:An accretion of epithelia in the external auditory canal.Keratosis obturans is a rare condition characterized by the accumulation of desquamated keratin material in the bony portion of the external auditory canal. Classically, it is reported to present with severe otalgia, conductive deafness and global widening of the canal.Keratosis obturans results from the accumulation of large plugs of desquamated keratin in the ear canal, and differs from external auditory canal cholesteatoma in which there is an invasion of squamous tissue into a localized area of periostitis in the canal wall. There appears to be no clear association between these two conditions. Keratosis obturans presents with hearing loss and acute severe pain, tends to be found in a younger age group, and is usually bilateral. There also appears to be a definite relationship between keratosis obturans and both bronchiectasis and sinusitis.Once considered rare in the population, keratosis obturans are surprisingly common in the population today. Healthy bodies maintain a cellular pH 7.35-7.45. This aids the outer layer of tissue called keratin to grow outward from the umbo of the eardrum at the rate of about 1mm per day, carrying with it dead skin tissues, debris, bacteria, fungi, and earwax. When the cellular pH of the body falls into acidosis (pH 7.1 or below), external ear keratin peels up from the skin below and wraps around itself over and over, until an entire milieu of collected material takes on a life of its own, in many cases becoming dangerously septic.Examination of the child with keratosis obturans is remarkable for a plug of a keratin that, when removed reveals a thickened but otherwise normal tympanic membrane. In the patient with keratosis obturans, there is generalized widening of the bony EAC. With EAC cholesteatoma, the tympanic membrane also may be intact. However, there is usually drainage and localized erosion of the canal lateral to the annulus.Extensive erosion of the bony meatus, with exposure of the facial nerve, has been previously reported, but no case of facial nerve palsy has as yet been published.Two cases of keratosis obturans as examples of epiderm migration disorders and difficulties in diagnosis and treatment of this disease. Keratosis obturans was diagnosed in both cases in histopathological and immunohistochemical examinations. Histopathological and molecular structure of keratosis obturans was discussed. In presented cases surgical, anti-inflammatory and keratinolytic treatment was applied.Symptoms:The patient may suffer from partial hear loss.
There may be severe pain in the ear.
Bronchitis can be seen in the patients occasionally.
Diagnosis:The diagnosis is based on the appearance. The ear canal appears to be widened, making the eardrum stand out. CT scan of temporal bones may reveal canal erosion and widening.After surgical removal under general anesthesia the specimen must be sent for pathological evaluation to rule out other malignancies.Treatment:The treatment of keratosis obturans includes the mechanical removal of the epidermal plug and periodic cleansing of the canal. Granulation tissue may be managed by removal, cauterization, or the use of topical steroid drops.NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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