Desquamated Keratin

A 53-year-old woman complains of right-sided ear pain with radiation down her jaw. She thinks the pain is associated with recent migraines she has been having. No change in hearing, no tinnitus or vertigo. She does not have any history of ear trouble. She has not had any fevers, nausea, or vomiting.

The patient has desquamated keratin or sloughing of a large number of skin cells.

It is easy to mistake desquamated keratin for cerumen (ear wax). This image nicely demonstrates both cerumen, which is in the lower-left portion of the image with desquamated keratin, which is in the upper-right. The cerumen is a globular, sticky substance while the keratin is a sheet-like, folded substance. Cerumen is a normal finding in a healthy ear. Large amounts of desquamated keratin are not seen in a healthy ear. It suggests that something has irritated the ear canal causing sloughing of the skin. In severe cases, this sloughing of the skin can be so extreme that it causes a painful and solid blockage of the ear canal known as keratosis obliterans. The keratin and the cerumen were removed with a combination of curette and irrigation. Here are side-by-side images of the canal before and after removal:  It’s apparent that the patient has several areas of irritation to the external auditory canal. An antibiotic ear drop with a steroid was prescribed. Follow up pictures were obtained that nicely demonstrate resolution of the inflammation of the ear canal: