Keratosis obturans masquerading as cholesteatoma- A case report

Keratosis obturans is a condition of the external auditory canal, characterised by the stratified accumulation of keratin plugs within the external auditory canal. The progressive accumulation of keratin debris can lead to the gentle erosion and widening of the canal eventually. Whereas, Cholesteatoma also known as active squamosal chronic suppurative otitis media (CSOM) is a benign keratinizing epithelialized cystic structure found in the middle ear and mastoid. It can cause destruction of the local structures – ossicular chain and otic capsule, thereby leading to complications such as hearing loss, vestibular dysfunction, facial paralysis and intracranial disease or infection. Both these entities may present with severe otalgia and conductive hearing loss with radiological evidence of bony erosions. The similarity in clinical presentation can cause confusion between these two conditions. We present a case of keratosis obturans that was misdiagnosed as active squamosal CSOM. The case was diagnosed and managed by microscope guided examination and exploration under general anaesthesia.