Keratosis Obturans Research Articles

External Auditory Canal Erosion at the 6 O'clock Spot.

To report a common site of external ear canal erosion in multiple pathologies, located inferiorly at 6 o'clock. Otology patients who came in 2023 for treatment of external auditory canal erosions. This clinical capsule is an observational report of the external canal's propensity to erosion at the 6 o'clock location. Patient treatments were canalplasty, mastoidectomy, and medical management. Documentation of the propensity to erosion at the 6 o'clock location in the external auditory canal. Locations of the niduses of prior series of external auditory canal pathologies are documented. Eight patients are presented with external auditory canal erosion in 10 ears originating at the 6 o'clock position medial to the bony-cartilaginous junction. No other patient with spontaneous canal erosion presented with their nidus of pathology in another canal location. (A review of 42 case series of 291 patients found that keratosis obturans and bisphosphonate-induced osteonecrosis tended to arise from the same 6 o'clock lateral bony canal location, while 26% of necrotizing otitis externa cases arose there.). The "6 o'clock spot" in the external canal is a common location of canal erosion for spontaneous wax and keratin collections and may be the precursor to keratosis obturans, bisphosphonate-induced osteonecrosis of the ear canal, and necrotizing otitis externa.

Prımary External Audıtory Canal Cholesteatoma

Abstract External auditory canal (EAC) cholesteatoma is characterized by a bony defect in the auditory canal with a cystic structure lined by keratinizing stratified squamous epithelium and retention of keratin debris. Clinically, patients present with chronic dull pain, otorrhea, or conductive hearing loss. Lamellar keratin debris in a bony defect in the case of an intact tympanic membrane is highly suggestive of external ear canal cholesteatoma. It must be differentiated from keratosis obturans. The locally erosive and indolent nature of cholesteatoma in the bony external ear canal may result in complications due to erosion into adjacent structures such as mastoid cells, semicircular canals, fallopian canal, and temporomandibular joint. The treatment options include conservative therapy and surgery. In this case report, we presented a 75-year-old male with a primary left EAC cholesteatoma underlining the diagnostic and therapeutic features of this rare disease.

A Clinicopathological Study of Aural Polyps: A Retrospective Analysis in a Tertiary Care Hospital.

Introduction Aural polyps are a misnomer. Any lesion can present as a mass in the external auditory canal. Aural polyps are proliferation of the granulation tissue due to long standing inflammatory process with associated otalgia and otorrhea. Objectives To document the clinicoradiological presentations, intraoperative findings, and histopathological diagnosis of aural polyp, correlating them. Methods In our study 81 patients underwent treatment for aural polyps in the department of Ear, Nose, and Throat (ENT) from April 1997 to April 2022. Results were tabulated, a simple descriptive analysis was done using the Statistical Package Social Sciences software, and the results obtained were represented as percentages and presented in tables. Results The majority (38) of the patients presenting with aural polyps were diagnosed with mucosal and squamous type of CSOM, and 22 with simple granulation polyps. There were also 5 patients with malignant otitis externa, 3 patients had glomus tumors, 2 patients with retained foreign bodies, and 3 patients with brain herniation. We also identified aberrant internal carotid artery, high jugular bulb, one patient had facial nerve neuroma, one patient had polyp from the tragus diagnosed with tuberculosis, one patient with keratosis obturans, and one with exostosis. Conclusion A thorough detailed examination and mastoid exploration with radiological and histopathological evaluation is mandatory for better defining the definitive treatment. Utmost care and meticulousness are advised for the surgeons while dealing with aural polyps to avoid any complications.

Synchronous bilateral idiopathic external auditory canal cholesteatoma: a case report and review of the literature

BackgroundExternal auditory canal cholesteatoma (EACC) is a rare pathological condition representing 0.1% of all new otologic cases. Bilaterality manifests in 10% of EACC cases. Similar disease processes include keratosis obturans (KO) and benign necrotizing otitis externa (BNOE). Diagnostic differentiation may not always be unexacting but does however influence management and eventual outcome. This study aims to briefly review the literature, describe an unusual case of synchronous bilateral primary EACC, and simplify the diagnostic challenges surrounding this disease.Case presentationA 66-year-old man with no relevant family history, no concurrent or intercurrent illnesses, having undergone no relevant surgery, and had visited the Department of Otorhinolaryngology regarding right-sided otorrhoea and aural pruritis 9 years ago. At the time, he was diagnosed clinically with KO. Nine years later after having defaulted follow-up, he presented again with the same symptoms. Oto-microscopy now revealed excavation of the posterior canal wall, keratinous desquamation, and an intact tympanic membrane. Oto-endoscopy demonstrated extension posteriorly into the mastoid segment of the temporal bone. Computed tomography evinced a soft tissue attenuating mass within the excavated sub-adjacent bone, with extension into the mastoid air cell system. The contralateral ear had a smaller epithelial defect of the canal floor with underlying tympanic plate erosion. A closed mastoidectomy with the reconstruction of the posterior canal wall was performed on the right ear. The left ear was managed conservatively with micro-suctioning and aural toilette. Six months post-surgery, however, the reconstructed posterior canal wall underwent necrotic breakdown. The contralateral lesion gradually progressed into a Naim et al. (2005) Stage III EACC.ConclusionThis case illustrates the diagnostic challenge presented by EACC and is unusual regarding its bilaterality. The importance of diagnostic differentiation, both in the management of this disease and in the prevention of its progression, is highlighted. The idea of oto-endoscopy as a routine clinical tool is introduced, and endoscopic images are compared to high-definition computed tomography scans of the affected temporal bones.

Onion Skin in the Ear Canal: Keratosis Obturans

Onion Skin in the Ear Canal: Keratosis Obturans

Abnormal bone loss in the external auditory canal of two adult humans from the medieval period of Germany—An attempt at differential diagnosis

AbstractAbnormal loss of bone in the external auditory canal (EAC) constitutes an underreported condition in paleopathology. Thus far, all reported cases were diagnosed as the result of an external ear canal cholesteatoma (EACC). Here, we report two cases from the medieval period in Germany that show enlarged EACs with perforations of the anterior and posterior EAC walls. The cases were studied macroscopically, with a digital stereo microscope and by conventional X‐ray and computed tomography (CT)‐imaging techniques. In Case 1, the resorption caused a “ballooning” of the EAC while signs of osteonecrosis were missing. We therefore conclude that keratosis obturans (KO) is the most likely diagnosis. In Case 2, the periantral region adjacent to the perforations of the posterior EAC wall exhibits large resorption cavities and sequestrum‐like structures, indicative of osteonecrosis. In this case, we arrive at the diagnosis EACC. Ear diseases encompass a broad spectrum of conditions, many of them with potentially severe impacts on past people. It is therefore suggested to address ear diseases more frequently in paleopathology. Thus far, only a very limited number of entities of ear diseases have been diagnosed in paleopathological studies, and no case of KO has been reported. The present study thus expands the spectrum of paleo‐otopathological diagnoses.

Keratosis obturans masquerading as cholesteatoma- A case report

Keratosis obturans is a condition of the external auditory canal, characterised by the stratified accumulation of keratin plugs within the external auditory canal. The progressive accumulation of keratin debris can lead to the gentle erosion and widening of the canal eventually. Whereas, Cholesteatoma also known as active squamosal chronic suppurative otitis media (CSOM) is a benign keratinizing epithelialized cystic structure found in the middle ear and mastoid. It can cause destruction of the local structures – ossicular chain and otic capsule, thereby leading to complications such as hearing loss, vestibular dysfunction, facial paralysis and intracranial disease or infection. Both these entities may present with severe otalgia and conductive hearing loss with radiological evidence of bony erosions. The similarity in clinical presentation can cause confusion between these two conditions. We present a case of keratosis obturans that was misdiagnosed as active squamosal CSOM. The case was diagnosed and managed by microscope guided examination and exploration under general anaesthesia.

Keratosis obturans: A rare cause of facial nerve palsy

Keratosis obturans, caused by the deposition of desquamated keratin plug in the external auditory canal can present with facial palsy. Young patients presenting with facial palsy, earache, and gradual hearing loss should be suspected for Keratosis obturans.

Contemporary management of keratosis obturans: a systematic review.

This study aimed to examine the medical literature regarding the natural history and management of keratosis obturans. PubMed was queried via the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, and the methodological quality of each study was assessed using the Methodological Index for Non-Randomized Studies criteria. Fifty-one studies were abstracted, and dual investigator screening resulted in five retrospective studies for final analysis. All studies included patients afflicted with either unilateral (n = 75) or bilateral keratosis obturans (n = 8). The definition of keratosis obturans was present in three studies: a desquamated keratin plug within the external auditory canal. Mean and median Methodological Index for Non-Randomized Studies scores were 9.5 and 9.5, respectively. All patients underwent keratosis obturans exenteration with microscopy. Two studies reported an outcome instrument to evaluate endpoints: marked stillette and audiometry. No complications were observed with follow-up periods from 3 weeks to 3.5 years. This comprehensive review highlights a lack of published evidence relating to keratosis obturans. However, it appears keratosis obturans treatment is safe and efficacious with identifiable clinical practice patterns.

A Novel Topical Treatment for Keratosis Obturans.

To present and evaluate the treatment of keratosis obturans (KO) using miconazole/triamcinolone 0.1% crème gauzes. A retrospective clinical capsule report. Twelve patients diagnosed with KO between January 2000 and July 2020 visiting our tertiary hospital setting, were retrospectively reviewed. Either miconazole/triamcinolone 0.1% crème gauzes or periodic microscopic removal of the keratin plug. No evidence of disease during microscopic inspection of the ear canal. Successful treatment with miconazole/triamcinolone 0.1% gauzes was seen in 4/7 patients (57%) and successful treatment of periodic cleaning of the ear canal was seen in 1/5 patients (20%). Topical treatment of KO with miconazole/triamcinolone 0.1% crème gauzes in the ear canal could be considered as a treatment option for patients diagnosed with KO.

Simultaneous External Canal Cholesteatoma and Keratosis Obturans: A Rare Case Report

Primaryexternal auditory canal cholesteatoma (EACC) is a rare entity. Its association with keratosis obturans (KO) was not documented. I report a rare case with co-existence of ipsilateral EACC and contralateral KO. From clinical presentation, radiological investigation, and operative finding; I conclude to describe this case with simultaneous external canal cholesteatoma and keratosis obturans.

Itchy Ears

Introduction Though itchy ears cause significant discomfort, patients generally do not consult a doctor till it becomes chronic. Moreover, itching as a symptom hardly receives any attention in non-dermatological clinics and is generally not considered as a condition worth evaluating. Thus, this study was performed to examine the predisposing factors of itchy ears and the outcomes of corresponding treatment. Materials and Methods This was a prospective observational study carried out over a period of 12 months (July 2019 to June 2020). The study included 200 patients belonging to the age group ranging from toddler to elderly (≤70 years) and presenting at the ENT OPD of a Tertiary Care Teaching Institute with the complaints of itching in one or both the ears. Following the diagnosis, appropriate treatment was started. The patients were then followed-up after 10 days, to note if symptom of itchiness in the ear(s) had relieved. Results Out of 200 patients, 89 presented with itchy ears due to various etiology, of which most common were otomycosis (N=30), allergic rhinitis (N=15), and keratosis obturans (N=10). However, majority of the patients (N=111) had impacted wax as the predisposing factor (trauma (N=27), abnormal anatomy (N=65), or hereditary (N=19)), resulting in itchy ears. On the 10th day, complaint of itchy ears was relieved in majority of the patients. However, amongst 30 patients, 3 patients with fungal infection of the external auditory canal still complained of itchy ears and thus, were referred to dermatologist. Conclusion Impacted wax was the most frequently observed predisposing factor and was commonly observed across all the age groups. Majority of the patients responded well to the treatment and were relieved of itchy ears.

The Thickness of the facial Nerve Sheath Consistently Varies by Region in Its Intra-Tympanic Course on Cadaveric Study.

Iatrogenic removal of intra-temporal disease processes, such as cholesteatoma and keratosis obturans, can be challenging when the facial nerve (FN) is involved. Despite this concern about possible FN injury during these procedures, our clinical observation has been that the diseased growth can be cleaned quite easily from the vertical FN epineurium. Therefore, we designed a cadaveric protocol to measure thickness of the FN sheath (epineurium) in horizontal, second genu and vertical FN segments and to correlate these measurements with surgical management of FN disorders. Fifty non-fixated (wet) cadaveric temporal bones were dissected over 1 year's time. The intra-temporal FN sheath epineurium was harvested from the mid-horizontal, second genu, and mid-vertical segments. Using a digital micrometric technique, the thickness of each sample was measured. Data analysis was performed using student's two-tailed, dependent t-test. Epineurial nerve sheath thickness was the least in the horizontal segment (mean 0.9 mm, range 0.040-0.140 mm), greater at the second genu (mean 0.19 mm, range 0.010-0.280 mm), and greatest in the vertical segment (mean 0.29 mm, range 0.170-0.570 mm). These differences were statistically significant. In cases of cholesteatoma and keratosis obturans involving the vertical FN, the disease process can be separated from the FN sheath because of the sheath thickness in this region. Disease in the horizontal segment involves a thinner sheath and separating the disease process from the nerve is more difficult in this area.

Keratosis Obturans of the External Auditory Canal With the Complication of Acute Taste Loss.

Keratosis Obturans of the External Auditory Canal With the Complication of Acute Taste Loss.

Surgical management of keratosis obturans

Surgical management of keratosis obturans

Imaging of temporal bone inflammations in children: a pictorial review.

Understanding the underlying pathophysiology and the patterns of disease spread is crucial in accurate image interpretation. In this pictorial review, the common and important inflammatory processes of the temporal bone in children will be discussed, and key computed tomography (CT) and magnetic resonance imaging (MRI) features described. Inflammatory processes are categorized by anatomical location: the petrous apex and the inner, middle and outer ear. A complete review of the literature is provided. Cholesteatoma, cholesterol granuloma and mucoceles are inflammatory processes that occur across the anatomical subsites of the temporal bone, whilst site-specific inflammatory processes include labyrinthitis ossificans in the inner ear and keratosis obturans in the external ear. Infection is a key cause of inflammation in the temporal bone, and specific infections include petrous apicitis, otitis media and necrotizing otitis externa. Finally, important mimics and do-not-touch lesions are considered. CT and MRI are complementary in assessing these disorders, as two of the most important diagnostic clues are the presence of bone erosion, best appreciated on CT, and true diffusion restriction as seen on MRI. Flow charts to assist in the diagnosis of paediatric temporal bone inflammatory disease are also provided. Paediatric temporal bone inflammatory processes are common and can have severe clinical sequelae. Timely intervention, facilitated by correct radiological diagnosis, can often prevent progression of disease, loss of hearing and systemic illness.

A Wolf in Sheep’s Clothing: Keratosis Obturans Causing Facial Nerve Palsy - A Case Report with Review of the Literature

Keratosis obturans is a benign disease caused by layered impaction of wax within the external auditory canal. It presents with acute onset of pain and ear blockade. The current report discusses a 24-year-old male patient with recurrent unilateral keratosis obturans associated with facial canal erosion and resulting in facial palsy. A detailed review of the literature is presented. Keratosis obturans can behave aggressively, resulting in significant erosion of the bone and intratemporal structural damage and complications. Timely intervention is vital.

Postauricular abscess: An uncommon presentation of keratosis obturans

Keratosis obturans (KO) is a rare disease involving the bony external auditory canal due to hyperkeratosis of epidermis and disturbance in the epithelial migration process resulting in deafness, otalgia, and inflammation of the ear canal skin. Complications are extremely rare. Here, we present a case of KO in an elderly female presenting as a postauricular abscess, an unreported occurrence first of its kind in the literature. A 67-year-old female patient presented with complaints of dull aching pain and decreased hearing in the left ear for 1 month and swelling behind and above the left ear for 2 weeks. On examination, there was impacted wax in the left external auditory canal and the tympanic membrane was not visualized. A high-resolution computed tomography of the temporal bone reported left otitis externa with soft-tissue density with fat strands in the left postauricular region. The patient underwent examination under microscope, followed by debridement and a subsequent cortical mastoidectomy. Histopathology confirmed the diagnosis of KO. KO is an uncommon condition caused due to occlusion of external auditory canal by desquamated keratinous plug. It is important to differentiate it with other common conditions, including necrotizing otitis externa, canal cholesteatoma, osteoradionecrosis of the external auditory meatus, and tumors of the external auditory meatus. Extracranial complications are rare, including extensive bony erosion and automastoidectomy with no intracranial complications reported till date. KO is a relatively rare condition more commonly seen in the younger age group, and postauricular abscess as a complication of KO has not been reported till date. We thus highlight the importance of awareness of such rare conditions of the external auditory canal, promoting early diagnosis, prompt treatment, and successful prevention of complications.

Keratosis Obturans Management

Keratosis obturans is a large accumulation of plaque from desquamated keratin distributed in the ear. The etiology of keratosis obturans remains unclear. Keratosis obturans generally occurs in young patients between the ages of 5-20 years and can attack one or both ears. Patients suffering from keratosis obturans and have a history of bronchiectasis or sinusitis reported 77% of adolescent cases, only 20% of adult cases. The diagnosis of keratosis obturance is made on the basis of anamnesis and clinical examination, while CT scan is performed to determine whether or not bone erosion is present. This disease can be controlled by performing clearance of the ear canal periodically every one to three months to reduce debris accumulation. Ear dropping of mixtures of alcohol or glycerin in 3% peroxide, three times a week can often be helpful.

Colesteatoma do Canal Auditivo Externo: Caso Atípico de Apresentação Bilateral

INTRODUÇÃO: O colesteatoma do canal auditivo externo é raro e muitas vezes assintomático apesar da insidiosa destruição óssea que vai causando no canal auditivo externo e estruturas vizinhas. Relatos de doença bilateral são episódicos e de causa idiopática. A keratosis obturans é o principal diagnóstico diferencial.CASO CLÍNICO: Criança, 13 anos, com colesteatoma bilateral do canal auditivo externo, com invasão da mastoide e erosão da cadeia ossicular no ouvido esquerdo. A doente apresentava quadro arrastado de otalgia bilateral, com otorreia esporádica e hipoacusia progressiva à esquerda. Após vários procedimentos cirúrgicos para erradicação da doença, mantém-se em vigilância anual sem recidiva aos 4 anos.CONCLUSÃO: Este caso realça a necessidade do reconhecimento precoce desta entidade pouco frequente, mas que pode cursar com lesões extensas e até irreversíveis. O tratamento cirúrgico é curativo, mas a vigilância regular é mandatória.