<prompt> Chalky white tympanic membrane is seen in:ASOMOtosclerosisTympanosclerosisCholesteatoma  <response>: Keratosis Obturans Primary canal cholesteatomaIt is accumulation of a large plug of desquamated keratin in the external auditory meatusSeen between 5 and 20 yrs of age i.e. younger age as compared to cholestealoma which is seen in middle ageMay be UL or Bilateral occasionallyIt may be associated with bronchiectasis and chronic sinusitis.Clinical FeaturesPain in the ear severe olatagiaHearing loss of conductive typeTinnitusEar discharge - sometimesPearly white mass of keratin is visible in the ear canalTympanic membrane is thickened and chalky white in appearanceEar canal is balloonedTreatmentRemoval by syringing InstrumentationPeriodic checkup should be done to see reaccumulationIf it recurs - keratolytic agent - 2 salicylic acid in alcohol can be tried. 