Keratosis obturans presents with the same complaint as earwax i.e. hearing loss. But that doesn’t mean that they are the same. Earwax is mostly a secretion of the ceruminous glands (a type of modified sweat glands) located in the skin of the ear canal, these secretions mixed with dead skin cells and hair shed from the canal make up earwax. Earwax is located in the outer hair bearing cartilaginous part of the ear canal unless pushed inwards by instrumentation.
Keratosis obturans is a collection of keratin along with earwax in the ear canal. Keratin is found in nails, hair and epidermis. It is responsible for the hardness of keratosis obturans. It is seen extending to the deeper bony part of the canal.
Symptoms and signs of keratosis obturans
- Reduced hearing
- Ear pain
- Ear fullness
It is more commonly seen in young females (<40 years) who are otherwise healthy. Although, an association with bronchiectasis and chronic sinus issues has been suggested. Initial otoscopic examination shows an earwax-like mass in the ear. Keratosis obturans is suspected when on instrumentation it is found to be hard unlike earwax which is soft to firm in consistency. Pressure effect of keratosis widens the deep bony part of the canal in the long term, this can be diagnosed on an X-ray or a CT scan. However, imaging isn’t always needed as it’s largely a clinical diagnosis. Earwax no matter how hard in consistency will not cause widening of the bony part of the ear canal.
(Image Source: radiopaedia.org)
Treatment
Debridement of the mass is the primary treatment of keratosis obturans. It is done with microscope or endoscope guidance. On lifting the edges of the mass, bone is either exposed or lined by very thin whitish epithelium. Many times, when bone is exposed or gets infected it becomes very painful to remove the mass. It’s imperative to remove the keratosis under general anesthesia in such cases. After complete removal of the mass, canal bone can get exposed, it is essential to prevent infection by applying topical ear drops, ointments or oral antibiotics. Chances of recurrence of keratin debris are high and patients may require regular ear cleaning. Without an expert opinion of an ENT doctor, it may go misdiagnosed as earwax for a long time.
