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False Tympanic Membrane with Keratosis Obturans Formation

Obliterated ear canal by bulging membrane (arrow) which formed complicating auditory meatus and temporomandibular joint injuries following motor-vehicle accident.  It felt soft and cystic.  Excision was performed under general anaesthesia.  Trapped haemoseous secretion and keratin flake/impissated material found and removed.

Part of trapped materials removed behind the false tympanic membrane.

Representative high resolution CT-scan in coronal cut showing the lesion (+).

Keratosis Obturans: Secondary-Acquired Stenosis of External Ear Canal

Crescentic dashed area depicts formed membrane secondary to longstanding keratosis obturans with had caused ear canal narrowing.  Arrows - keratin material discovered during micro-ear toilet which was removed.  The membrane was excised to regain optimal opening for ease of ear cleaning during outpatient follow-up.

Keratosis Obturans: An Intraoperative View

Red dash - granulation tissue, K - keratin, (*) - earwax, TM - tympanic membrane, while line - handle of malleus (right).

Endoscopic view 1 week later showing resolving granulations and more obvious dip of the osseous canal floor.  The eardrum (TM) appeared retracted with the tympanic cartilaginous ring became visible.  (Arrow -  handle of malleus)



 Keratosis obturan materials removed.

Endoscopic view of the ear canal 2 weeks after successful clearance and completion of antibiotic therapy (same patient as depicted in the video above).  No residual keratin or granulation tissue seen.

Keratosis Obturans

Abnormal epithelial migration and turnover in the presence of impated earwax predispose to localized or generalized cumulation of keratin and desquamated epithelium in the ear canal.  In longstanding cases, these result in bony resorption and expansion aliken to flask or hour-glass appearance.  The above figure shows a widened ossous meatus and a local whitish keratin layer on the floor of ear canal in a patient who just had an ear toilet performed for recurrent ear wax.

Endoscopic view of right ear canal during micro-ear toilet.  Top left image shows keratosis obturans material (KO), and top right image upon completion of procedure with the patient lying down in supine position. 

[TM - tympanic membrane, A - anterior, I - inferior, S - superior]


   This image shows the effect of long standing keratosis obturans

on the ear canal appearance after successful treatment given.

[stars- shallow defect secondary to bony resorption]


The normal external auditory meatus for comparison.

 Exposed fibrocartilaginous rim of tympanic membrane (arrows) in a patient with healed keratosis obturan.

Keratosis Obturans with Granulation Polyps Formation

TM - tympanic membrane, arrows - granulation polyps

Solitary granulation (X) one week after removal of keratosis obturan lesions.  An antibiotic course was prescribed. 

The Ossicles as Seen in Atectatic Eardrum in a Previously Treated Keratosis Obturans

                                        1- malleus, 2- incus, arrow- stapes

Keratosis Obturans with Mastoid Erosion

TM - tympanic membrane, arrow - chorda tympani, (+) - mastoid cavity, X - epitympanum. 


Close up view of eroded posterior ear canal wall with mastoid cavity in view (+).