Keratosis obturans happens because of ear canal skin peel depositing in an abnormal way and destroying the underlying bone. This causes ear blockade, earache and later giddiness, hearing loss and facial weakness or paralysis.
Keratin is basically a protein found in the skin and the whole skin is normally shredded off in 21 days.
this normal skin migrates normally outwards in the ear canal but in keratosis obturans, this skin peels keep depositing there itself.
These skin peels secrete some enzymes which absorb the underlying bones as well.
As you can see in this picture that the normal skin migrates from the eardrum to the posterior canal wall and comes out of the ear canal.
But when this migration process faulters or when it encounters some obstruction en routes like a foreign body or impacted wax, then it starts depositing there itself
This is more aggressive than other skin conditions.
This peeled skin gets some obstruction because of hard wax or some migratory issue, then it starts collecting locally
This is very aggressive and with a very short history at most 2-3 months or rarely 6 months.
This is aggressive because the whole point of pressure is towards the underlying bone.
This destroys the underlying bone rapidly.
The person won't had any ear problem since childhood and you have normal hearing but all of a sudden, you start noticing discomfort in the ear for the last few days
Now blockade sensation or ear pain has increased so much because of the resorption of bone with the disease.
There is one more skin disorder of the ear known as CHOLESEATOMA but in this, the behavior is totally different than Keratosis.
In cholesteatoma, skin also plays a part but it exerts uniform pressure in all directions and it is a loose mass.
but keratosis point of thrust is towards the bone which is why it is much more aggressive.
So, I have told you about the pathology and clinical feature of this condition.
And in very severe keratosis, the face may also get paralyzed but usually, it starts with some facial asymmetry.
40% of cases of keratosis also present with vertigo with involvement of the middle ear inside the eardrum especially a balance organ known as a semicircular canal. this happens particularly in moderate to severe keratosis Obturans.
So, we have classified Keratosis Obturans according to clinical severity into mild, moderate, or Severe (massive).
In mild cases, only the outer ear canal is involved without the involvement of any vital structure and with some widening of the ear canal
In moderate cases, keratosis involves the middle ear inside the eardrum and involves the vital structures such as the semicircular canal (causing vertigo) or facial nerve (causing facial asymmetry)
In massive cases, there is much more injury to the vital organ causing dead ear and complete facial paralysis and it has progressed towards the skull base as well
So, the primary treatment for this condition is only surgery. Milder cases can be treated in the clinic as outdoor procedures.
the patient has to come repeatedly for suction clearance.
But in more advanced cases, this requires surgical removal properly.
the affected bone is drilled, and polished and then a layer of normal fascia is spread over the exposed bony area.
and if it involves the middle ear, then tympanoplasty with or without mastoidectomy is done.
and the exposed vital structures are covered with a graft.
So, this is very important for everybody to attend to complaints of fullness in the ear and have regular checks up from an ENT doctor.
The skin is normally a protective layer but becomes a dangerous organ in some conditions like this. The skin inside the ear canal is something special as it migrates outside but in this condition, it migrates in a reverse way.
So, I hope that you would have gained insight into this condition through this video.
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00:00 case study- Keratosis obturans
01:12 Keratosis obturans formation
01:44 Why so aggressive- Keratosis obturans
02:14 Keratosis obturans- Clinical features
02:41 Keratosis obturans Vs Cholesteatoma
03:39 Classification keratosis obturans
04:25 Treatment of keratosis obturans
05:17 Importance of regular ENT check up