Keratosis Obturans: A Disease of the Tropics?

Abstract

Keratosis obturans appears to be an obscure and relatively uncommon entity, even in literature search of journals and reference texts, so much so that there is not even any prevalence or incidence statistics available. However, the condition did not appear to be as uncommon based on our clinical observations. We have managed to obtain 64 patients representing 67 ears with keratosis obturans in our study period of about 18 months with a pattern of occurrence during this period. Humid weather seemed to play a role in the frequency of its appearance during certain period in our observation. There also appears to be a correlation between the severity of symptoms (predominantly pain and hearing loss) and the presenting appearance of the condition, i.e., presence or absence of granulation tissue, as well as that the degree of difficulty in exenteration of the keratosis obturans (matrix and content) depending on the expansion of the bony canal. Our figures showed the majority of the patients are females and young individuals, the majority of them occur unilaterally. The condition also appear to stop short of involving the tympanic membrane with only the bony canal being expanded with the surrounding oedema creating an apparent "canal stenosis".

A Recurrent Misdiagnosed and Maltreated Case of Keratosis Obturans

“…The diagnosis of KO, as a clinical entity, is often reached only after attempting to remove the accumulated desquamated keratin from deep in the ear canal, which causes intense pain and the appearance of a silvery white peripheral matrix. Bleeding may occur as a result of the stripping or peeling off of the matrix, which may be the result of neovascularization; the formation of new capillaries around the matrix is most likely the outcome of inflammation or irritation of the neighboring skin of the bony canal [ 19 ]. We believe that if a patient is encountered with thick impacted wax showing unusual characteristics that cannot be removed after several attempts on different occasions, other pathologies should be considered.…”

Contemporary management of keratosis obturans: a systematic review

“…With respect to the five studies, one was from the USA, two were from Korea, one was from Japan and one was from Malaysia. [9][10][11][12][13]…”

“…Furthermore, Chong and Raman developed a grading system for keratosis obturans, which was otherwise unprecedented in the otolaryngology literature. 13 Finally, three studies mentioned the use of temporal bone computed tomography to either confirm the presence or assess the extent of keratosis obturans.…”

“…12 One study noted 'conductive hearing loss of mild to moderate severity in pure tone audiometry (10-30 dB air-bone gap)'. 13 No studies commented on the validation of the outcome instrument utilised for evaluation of their corresponding endpoints.…”

“…Prior authors have noted that keratosis obturans is often only confirmed when multiple attempts at removal of accumulated desquamated keratin elicit excruciating pain and a silvery-white matrix at the periphery of the plug is able to be visualised. 13…”