Keratosis Obturans: A Rare Cause of Facial Nerve Palsy

Case Report

Austin J Otolaryngol. 2015;2(4): 1039.

Keratosis Obturans: A Rare Cause of Facial Nerve Palsy

Ahmad Nasrat Al-Juboori*

Department of Otorhinolaryngology, Head and Neck Surgeon, Al-Iraqia University, Iraq

*Corresponding author: Ahmad Nasrat Al-Juboori, Department of Otorhinolaryngology, Head and Neck Surgeon, Ibn Sina College of Medicine, Al-Iraqia University, Baghdad, Iraq

Received: February 10, 2015; Accepted: March 31, 2015; Published: April 02, 2015

Abstract

Keratosis obturans is a rare condition characterized by the accumulation of desquamated keratin material in the bony portion of the external auditory canal (EAC). It is thought that keratosis obturans is due to abnormal epithelial migration of ear canal skin. Classically, it is reported to present with severe otalgia, conductive deafness and global widening of the canal. The frequency of keratosis obturans has been estimated as 4-5 in 1000 new otological cases. Extensive erosion of the bony meatus, with exposure of the facial nerve, has been previously reported as one of the complications, on Medline the 1st published such complication in 2006. The purpose of this case report was to presents a rare and probably the first reported keratosis obturans in Iraq that caused facial palsy.

Keywords: Keratosis obturans; External auditory canal; Cholesteatoma

Introduction

The presence of a keratin plug occluding the deep external auditory canal was first noted and documented in the 19th century. Keratosis obturans is a rare condition characterized by the accumulation of desquamated keratin material in the bony portion of the external auditory canal (EAC) [1]. The keratin squames are shed from the complete circumference of the deep ear canal forming a lamina (onion skin) arrangement. It is thought that keratosis obturans is due to abnormal epithelial migration of ear canal skin [2]. It may be associated with sinusitis and bronchiectesis. The frequency of keratosis obturans has been estimated as 4-5 in 1000 new otological cases [2]. Classically, it is reported to present with severe otalgia, conductive deafness and global widening of the canal [3]. CT scan used for the diagnosis, it shows typical ballooning of the bony external meatus [2]. It has subsequently been proposed that two different diseases can be responsible for the presence of this type of obstruction within the deep meatus, keratosis obturans and external auditory canal cholesteatoma (EACC). Extensive erosion of the bony meatus, with exposure of the facial nerve, has been previously reported as one of the complications, on Medline the 1st published such complication in 2006 [3,4]. The pain and deafness associated with keratosis obturans means that is necessary to remove it, often under general anesthesia. Canalplasty has been suggested for recurrent keratosis obturans. The purpose of this case report was to presents a rare and probably the first reported keratosis obturans that caused facial nerve palsy in Iraq.

Case Presentation

A 42-year-old female patient from Al-Fallujah city presented to us on December 2012 complaining from recurrent left sided earache for the last three months, this complaint was associated with hearing impairment on the same side there was no associated ear discharge, and she consulted ENT clinics without benefits. On examination there was facial asymmetry with flattening of the left nasolabial fold, examination of the facial nerve revealed left sided facial nerve weakness mainly on the lower half of the face (Figure 1a). Otoscopic examination showed a very large piece of keratinous material filling the left EAC which was removed completely (Figure 1b).