Pseudomonas aeruginosa infections in diabetics or immunocompromised people cause malignant otitis externa (skull base osteomyelitis). It behaves as a malignancy but not a proper malignancy. Associated with severe ear pain & granulations in ear canal with or without facial paralysis depending on the extent of invasion of lesion. Antipseudomonal antibiotics like ceftazidime should be given systemically, surgical debridement needs to be done later if required. Ga-67 scan shows soft tissue involvement and Tc-99 scan shows bony damage.
Keratosis obturans is a condition where failure of normal migration of squamous epithelium onto meatus occurs and a collection of a pearly white mass of desquamated epithelial cells occurs in the deep meatus.
Wax in the canal is a mixture of secretions of sebaceous glands & ceruminous glands, hair, desquamated epithelial debris, keratin & dirt. It can be removed by syringing with water (at body temperature). Cold or hot water used for syringing can cause vertigo by stimulating lateral semicircular canal. Sometimes impaction of wax occurs due to narrow & tortuous canal, stiff hair or obstructive lesions, these needs to be softened first before syringing. Foreign bodies – If there is live insect, instill oil first to kill it and remove with suction/forceps/syringing.