Learning Objectives:

A Case Report of Keratosis obturans - often misdiagnosed

Introduction: A case report of Keratosis Obturans in a 32 year female patient. The condition is often misdiagnosed and requires careful history taking and clinical examination to diagnose and rule out the disease. It should be differentiated from external auditory canal cholesteatoma, presence of osteonecrosis and focal overlying epithelial loss are the most reliable features favouring the diagnosis of external ear canal cholesteatoma over keratosis obturans

Materials and Methods: All the necessary investigations viz. routine Blood investigations, serological profile, imaging studies i.e HRCT Temporal bone both sides along with orthopantogram to rule out (TM)Temporo-mandibular joint involvement was done, Pure tone Audiometry was done which showed moderate to severe conductive hearing loss on the affected side.

Patient was planned for surgery under GA.

Result: While operating large keratotic mass was seen extending superiorly into tegmen, posteriorly into mastoid extending upto tip cells, anteriorly involving TM joint, the entire keratotic mass was removed and bone was drilled, wide canal meatoplasty was done, excised mass was sent for HPR and was confirmed as keratosis obturans, post operative CT scans were done to recheck.

Conclusion: Keratosis obturans is a rare disease and often misdiagnosed, proper diagnosis with help of imaging modalaties is essential to plan for surgery and eradicate disease.

Trauma and anatomical deformity of TM joint and EAC might be a precipitating factor.