Draft:Keratosis obturans

Keratosis obturans
Classification and external resources
ICD-10	H60.40
ICD-9-CM	380.21
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Keratosis obturans is a disorder of keratin formation that involves the external ear canal accumulating cholesterol granules, which may lead to bony erosion.

The exact etiology is not known. It appears to be result of abnormal shedding of the epithelium and failure of migration of the cell from the surface of the tympanic membrane, which leads to accumulation of a mass. The keratin plugs are shed from all sides of ear canal. It looks like onion skin. A mass thus formed causes erosion and widening of the bony canal. It is sometimes associated with excess cerumen (wax) formation. Bronchiectasis, chronic sinusitis, and old age chronic smoking are risk factors.

The ear canal appears to be widened, making the ear drum 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 malignancy.

On examination with the help of otoscope, it is very essential to differentiate keratosis obturans from cerumen (wax). Cerumen is the accumulated secretion from glands. It appears black or brown. However, if you examine a case of cholesteatoma with an otoscope, it looks like a pearly-white mass.

Removal of mass from the deep meatus to be performed under general anesthesia. Frequent cleaning may retard process of accumulation. Cleaning may be much easier if the typically inspissated and adherent material is softened with mineral oil. Surgical intervention rarely indicated, unless the erosion is very deep.

The variation in technique in cholesteatoma surgery results from each surgeon's judgment whether to retain or remove certain structures housed within the temporal bone in order to facilitate the removal of cholesteatoma. This typically involves some form of mastoidectomy which may or may not involve removing the posterior ear canal wall and the ossicles.

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