Chalky white tympanic membrane is seen in-

Keratosis Obturans (Primary canal cholesteatoma) It is accumulation of a large plug of desquamated keratin in the external auditory meatus Seen between 5 and 20 yrs of age (i.e. younger age as compared to cholesteatoma which is seen in middle age) May be U/L or Bilateral (occasionally) It may be associated with bronchiectasis and chronic sinusitis. Clinical Features Pain in the ear (severe olalgia) Hearing loss (of conductive type) Tinnitus Ear discharge – sometimes O/E Pearly white mass of keratin is visible in the ear canal Tympanic membrane is thickened and chalky white in appearance Ear canal is ballooned Treatment Removal by syringing / Instrumentation Periodic checkup should be done to see reaccumulation If it recurs – keratolytic agent – 2% salicylic acid in alcohol can be tried. NOTE: The answer to this question should have been ‘desquamated epithelium’ only but since it is not given in options – we are choosing the next best option.