Keratosis Obturans

(External ear canal cholesteatoma)

Keratosis obturans: is accumulation of desquamated keratin in the external ear canal.

Pathology: These keratin squames are shed from the complete circumference of the deep ear canal forming a lamina. It appears like onion skin.

Etiology: Keratosis obturans is postulated to occur due to abnormal epithelial migration of ear canal skin. Self cleaning mechanism of external ear going haywire: The self cleansing mechanism of the external ear canal is the net result of the finely coordinated processes of keratin maturation and lateral cell migration. In keratosis obturans, this mechanism is nonfunctional.

Keratosis obturans commonly occur in young patients.

Clinical features:
1. Ear pain and blockage
2. Hearing loss
3. Associated bronchitis / sinusitis – common
4. Ear discharge

On examination:
The ear canal appears to be widened, making the ear drum stand out. CT scan of temporal bones may reveal canal erosion and widening.


1. Microscopic ear cleaning (sometimes under GA)
2. Canalplasty (operation to widen the ear canal) is helpful in recurrent cases