When it comes to blockages of the ear we find in practice that it is not always ear wax. There can be a number of other conditions. Today I will discuss: ‘Keratosis Obutrans’ which we see in 2% of cases in visits to our ear wax removal clinics. The post aims to promote awareness around this condition, which, although rare, ear wax removal clinics frequently encounter. Most clinics are unlikely to diagnose it routinely in primary care because, when they inspect the ear canal, it resembles just a collection of dense ear wax.
Keratosis Obutrans (a dead thickened skin plug in its simplest terms) usually forms over a long time neglected by clients. Once they decide to address the discomfort and blockage in the ear they might visit a number of ear wax removal clinics after unsuccessful attempts. The issue here is that most clinics think they are dealing with a compacted wax issue which fails to respond to microsuction and irrigation sometimes making the issue worse by causing inflammation or infection. This is due to water trapping in the ear and increased humidity. Clients can continue making repeated visits to ear wax removal clinics in the assumption that they have stubborn ear wax.
Keratosis obutrans will not usually extract through microsuction alone. If microsuction is to work, you will need to know what you are dealing with and use certain techniques to peel away the plug from the ear canal and extract it out. The only way to diagnose it is when we perform microsuction: you will be able to see a silvery white matrix around the periphery of the plug. Clients start to develop earache and a sharp drop in their hearing.
A specialist should deal with this type of condition. This is because non-healthcare professional will more than likely fail to diagnose and tackle the condition. as it is not a simple case of ear wax.
Here at EarwaxDoc we have extensive experience in dealing with keratosis obutrans. We see one case on average every two weeks. Best practice is to loosen the plug by microsuction and then extract it with a forcep. If there is any underlying inflammation or infection, then it’s best to refer to GP. Usually, a 7-day course of topical antibiotic helps post extraction reducing any inflammation. The condition can reappear and it is advisable to address any concerns earlier. This will help prevent complications.
Clients normally feel an immediate relief and return of their hearing.
You will be able to see in the picture above the dead skin plug.Abnormal accumulation of desquamated skin forms this. Minor bleeding is normal during the removal of the dead skin plug. This is because the newly formed capillaries within the dead skin plug matrix rupture.
If left untreated the plug can expand within the auditory canal and start widening the bony external ear canal. This is what results in severe pain (otalgia) due to the pressure on the sensitive ear canal walls. You do not normally get any discharge from the ear with keratosis obutrans. We’re happy to answer questions and raise awareness about this condition; contact our clinic.
Important points to remember:
-Use sodium bicarbonate ear drops for a few days before removal to loosen the keratosis obutrans skin plug for easier detachment.
-Ensure the specialist you use is a registered healthcare professional who has experience in removing keratosis obutrans.
-After procedure check if you need a referral to your GP for a prescription for topical antibiotic to reduce inflammation and infection.
-Try to catch the condition early if it appears to avoid any complications like ear canal widening or pain.
