Keratosis obturans the skin of the eardrum and the external auditory canal has the unique ability to migrate off the drum, then along the canal towards the exterior, carrying wax and any debris with its movement. Definition accumulation of desquamated keratin in the external auditory meatus. Keratosis obturans is a hyperkeratotic growth of superficial skin of the bony ear canal skin and as such is seborrheic dermatitis of the bony ear can. Keratosis obturans, external auditory canal cholesteatoma, ear wax, ear ache. Keratosis obturans cause conductive hearing loss by blocking the ear passage. Keratosis obturans are common in the population today. Symptoms are acute severe otalgia and conductive hearing loss. Keratosis obturanstwo cases with different aetiologies. What are the histologic findings characteristic of keratosis.
A recurrent misdiagnosed and maltreated case of keratosis. It may occlude the canal and cause erosion of bone. Today, we have 120 million americans with prediabetes ph 7. This migratory action is intended to prevent the buildup of matter in the deep canal, deafening the ear. All patients complained of tinnitus and other aural symptoms. We can find no previous record of an identical case in the dermatologic texts or literature.
Keratosis pilaris appears similar to gooseflesh, is usually asymptomatic and may be treated by moisturizing the skin. Keratosis obturans uf health, university of florida health. Contrary to cholesteatoma, keratosis obturans is often bilateral. Ct imaging of keratosis obturans typically demonstrates a softtissue plug in the bilateral eacs, without focal bone erosion of the canals 4, 14. The author, in research screenings has found obturans in up to 3035% of such individuals. Keratosis obturans and external ear canal cholesteatomas have been considered as separate entities for the last 20 years, after being regarded as variations of the same disease for at least 87 years. Exposed fibrocartilaginous rim of tympanic membrane arrows in a patient with healed keratosis obturan.
As mentioned earlier, a drop in the bodys cellular ph into acidosis state can cause the peeled keratin issue. The pathologic features of keratosis obturans and cholesteatoma. Pathology the keratin squames are shed from the complete circumference of the deep ear canal forming a lamina. Keratosis obturans ko is a rare disease involving the bony external auditory canal caused by hyperkeratosis of epidermis and disturbance of the epithelial migration process. The disease may lead to erosion and widening of the. Another external ear condition frequently described is external ear canal cholesteatoma eacc. Keratosis of the tympanic membrane and deep external. The role of imaging in preventing facial nerve injury audiometry revealed a conductive hearing loss in 2 of these patients mild in 1 and mild to moderate in the other, a profound left sided sensorineural hearing loss and a mixed rightsided hearing loss in 1 patient, and. Seven years later tympanotomy revealed a glomus tumour, confirmed by histolog. Silent keratosis obturans causing exposure of the facial nerve. Keratosis obturans is estimated to occur among 4 to 5 patients among. Keratosis obturans was first properly described by wreden of st.
Microscopic examination histopathology of keratosis pilaris kp lesions shows the triad of epidermal hyperkeratosis, hypergranulosis, and plugging of individual hair follicles. Return to article details keratosis obturans download download pdf return to article details keratosis obturans download download pdf pdf. Immunohistochemical and histopathological features of keratosis obturans and cholesteatoma of the external auditory canal. Surgical management of keratosis obturans csurgeries. Laminated epithelial plug keratosis obturans ko is a rare condition characterized by an. Digicare monograph series beware the septic keratosis obturans. External auditory canal cholesteatoma and keratosis obturans. This image shows the effect of long standing keratosis obturans. Hyperkeratosis lenticularis perstans also known as flegels disease is a cutaneous condition characterized by rough, yellowbrown keratotic, flattopped papules 639. Eacc with those of a similar entity, keratosis obturans. The presence of a keratin plug occluding the deep external auditory canal was first noted and documented in the 19th century.
In the histopathologic examination, keratin blockage found in. Keratosis obturans usually affects younger age group, occurs bilaterally and manifests as severe otalgia, conductive hearing loss and widened ear canal. It is clinically diagnosed when removal of the debris shows silvery white peripheral matrix and causes excruciating pain. Keratosis obturans is an unusual, chronic condition in which a cholesteatoma like mass is found in the depths of the external. The current report discusses a 24yearold male patient with recurrent unilateral keratosis obturans associated with facial canal erosion and resulting in facial palsy. If you continue browsing the site, you agree to the use of cookies on this website. Keratosis obturans ko is a rare condition characterized by an accumulation of desquamated keratinous material forming a plug that occludes the external auditory canal morrison 1956. The removed specimen was sent for histopathological examination.
Sequences of otoscopic photography of daubs of dye placed on the tympanic. Keratosis obturans is a condition of the external ear canal and could be. It is significant that a definite relationship existed between the distribution of the bronchiectasis and the side or sides involved by keratosis obturans. Keratosis obturanstwo cases with different aetiologies the. Additionally, keratosis obturans generally occurs in a younger age group, it is often bilateral, and it has a definite relationship to bronchiectasis and sinusitis 2, 14. It presents with acute onset of pain and ear blockade. Epithelial migration in keratosis obturans rogan john corbridge, frcs, leslie michaels, md, frcpath, and tony wright, llm, dm, frcs ial comment. Keratosis obturans is a condition of the external ear canal and could be described as an intensification of keratin plugs within the canal. While both disorders are distinct, they do have some overlapping characteristics which may make it difficult to reach a definite diagnosis. Keratosis obturans is a benign disease caused by layered impaction of wax within the external auditory canal. Keratosis obturans presents as hearing loss and usually acute, severe pain secondary to the accumulation of large plugs of desquamated keratin in the ear canal. Follicular hyperkeratosis, also known as keratosis pilaris kp, is a skin condition characterized by excessive development of keratin in hair follicles, resulting in rough, coneshaped, elevated papules. Diagnosis requires ct scanning of the temporal bone, histopathological. Pdf keratosis obturans is a large accumulation of plaque from desquamated keratin distributed in the ear.
Accumulation of keratin debris deep within external auditory canal, which may cause bone remodeling and inflamed. Immunohistochemical and histopathological features of keratosis. It may be due to a problem with how skin cells in the ear canal are produced. Keratosis obturans is an unusual, chronic condition in which a cholesteatomalike mass is found in the depths of the external auditory canal. The cartilaginous portion of the canal is not involved. Keratosis obturans is the accumulation or buildup of keratin layer of the epidermis desquamation in the ear canalpearly whitethus forming clots and cause a full flavor and keeatosis heard. Often, there is clinical and histopathologic overlap between this condition and a cholesteotoma of the external auditory canal ceac. There are many others, most of which are rare or have an inherited genetic basis. Clinically presents as otalgia, conductive hearing loss and recurrent infection. Patients suffering from keratosis obturans and have a. Mancini md, in hurwitz clinical pediatric dermatology fourth edition, 2011 keratosis lichenoides chronica. This is a report of a rare condition observed in a patient in private practice which should be interesting to the otologist as well as to the dermatologist. Keratosis obturans complicated with facial nerve palsy.
The keratosis was bilateral in 22 and unilateral in 28 cases. Silent keratosis obturans causing exposure of the facial. Well diff polygonal cells with prominent nuclei, keratin pearls, intercellular bridges, dyskeratotic cells. Histopathologic examination revealed cyst wall covered with. Nov 01, 1996 epithelial migration in keratosis obturans rogan john corbridge, frcs, leslie michaels, md, frcpath, and tony wright, llm, dm, frcs ial comment. Keratosis obliterans usually found on a bilateral basis and may be accompanied by bronchiectasis and chronic sinusitis. When called phrynoderma the condition is associated with nutritional deficiency or malnourishment. Keratosis obturans commonly occurs in a younger patient group, often in patients with a history of sinusitis or bronchiectasis. There are a variety of causes which lead to several different types of keratosis. Epithelial migration in keratosis obturans sciencedirect. The authors argue that keratosis obturans is a sequela of abnormal epithelial migration across the tympanic membrane and out the ear canal.
Keratosis is an excessive growth of keratin, a skin protein, on the skin. 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. Keratosis lichenoides chronica is a rare, chronic, progressive, dermatosis that is much more common in adults than in pediatric patients. From wikipedia, the free encyclopedia keratosis obturans is a relatively uncommon ear disease, where dense plug of keratin is present in the deep meatus of the ear. Undiagnosed wax keratosis may lie passively for a long period without revealing any symptoms. This blocked ear wax removal extraction procedure is performed by uk pioneer and worldleading endoscopic ear wax removal specialist mr neel raithatha consu. We have previously described the pathways of movement of epithelium on the tympanic membrane, showing that there are two discrete and separate zones. Although the origin of this condition remains uncertain, it is thought to be due to chronic hyperemia of the external meatus. Typically seen in younger age group and can occur bilaterally. It has subsequently been proposed that two different diseases can be responsible for the presence of this type of obstruction within the deep meatus. Keratosis obturans and external auditory canal cholesteatoma. Keratosis obturans ko is the buildup of keratin in the ear canal. Keratosis obturans and external ear canal cholesteatoma.
This disease has been long considered as a single entity with external auditory canal cholesteatoma, but current consensus indicates that these are indeed two. Aug 11, 2020 keratosis obturans is a condition of the external auditory canal eac characterised by formation and accumulation of desquamated keratin resulting in varying symptoms. Keratosis obturans appears to be an obscure and relatively uncommon entity, even in literature. The author refers to this as the ears equivalent of an ingrown toenail, where. Keratosis obturans management ejournal unair universitas. A recurrent misdiagnosed and maltreated case of keratosis obturans. Keratosis obturans is a relatively uncommon ear disease, where dense plug of keratin is present in the deep meatus of the ear. The pathology was compatible with keratosis obturans ko. Request pdf on apr 1, 2004, jerzy kuczkowski and others published immunohistochemical and histopathological features of keratosis obturans and cholesteatoma of the external auditory canal.
Abstract keratosis obturans and external auditory canal cholesteatoma eacc have previously been considered to represent the same disease process. Keratosis obturans is an accumulation of obstructing desquamated keratin plugs in the external ear canal. Histopathology keratosis obturans histopathologically the thickened of epithelial layer and subepithelial layer exhibit a combination of dilated capillaries and infiltration of chronic inflammatory cells. It consists of cumulation of keratin and entrapped earwax which had been laid. The disease may lead to erosion and widening of the external auditory canal. Keratosis obturans is a large accumulation of plaque from desquamated keratin distributed in the ear. Keratosis obturans, auditory canal of springerlink. In patients who have undergone bone erosion ear canalsurgery is required to perform,eratosis tissue under the skin grafts to eliminate echo in the ear canal. In many cases the keratosis obturans can become septic with an admixture of live bacteria, fungi, amoeba, and viruses figure 2 to see a typical microbial assay of a septic keratosis obturans. What are the histologic findings characteristic of. Immunohistochemical and histopathological features of. On support examination of ct scan obtained erosion and widening of. Keratosis obturans is estimated to occur among 4 to 5 patients among new otological cases.
This website is intended for pathologists and laboratory personnel but not for patients. Seborrheic keratosis symptoms and causes mayo clinic. There is an associated hyperplasia of the underlying epithelium and evidence of chronic inflammation within the subepithelial tissue. Four cases of keratosis of the tympanic membrane and deep external auditory canal are here reported. The epidermal plug formation may occur due to faulty migration or excessive production of epithelial cells, as proposed by paparella and. The histopathology examinations of the granulation tissues sent were reported as acute. Keratosis obturans generally occurs in young patients between the ages of 520 years and can attack one or both ears. Return to article details keratosis obturans download download pdf return to article details keratosis obturans download download pdf thumbnails document outline attachments. Extension to adjacent structures can occur and result in further complications. Patients suffering from keratosis obturans and have a history of bronchiectasis or sinusitis reported 77% of adolescent. The etiology of keratosis obturans remains unclear. The three most common types of keratosis are keratosis pilaris, actinic keratosis, and seborrheic keratosis. Keratosis obturans is an obscure entity characterized by accumulation of desquamated keratinous material in the bony portion of the external auditory canal.
Excessive accumulation of desquamated epidermis in the external ear canal leads to deafness, otalgia, and inflammation of the skin of the canal. Differential diagnosis includes keratosis obturans, necrotizing external otitis and. External auditory canal cholesteatoma presents as otorrhea with a chronic, dull pain secondary to an invasion of squamous tissue into a localized area of periosteitis in the canal wall. Or, it may be caused by overstimulation of the wax glands by the nervous system. Keratosis obturanstwo cases with different aetiologies the british. Of the 20 bronchiectatic cases, in 15 both lungs and both ears were affected and in 4 one lung and the ipsolateral ear. To arrange an ear wax removal appointment please visit our website. Keratosis obturans is characterized by a dense plug of keratin debris located primarily within the deep meatus. Keratosis obturans definition of keratosis obturans by. The openings are often closed with a white plug of encrusted sebum.
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