Outpatient Management of Aural Fullness: A Retrospective Case Series of 100 Patients with Cerumen Impaction, Keratosis Obturans, and External Auditory Canal Cholesteatoma

Background: Aural fullness is a common symptom in routine otolaryngological practice. Although it is most commonly attributed to cerumen impaction, other, less frequent conditions may present similar symptoms and are often initially misdiagnosed as cerumen. These include keratosis obturans (KO) and external auditory canal cholesteatoma (EACC). Accurate differentiation among these entities is crucial for appropriate management. These distinctions are crucial for appropriate management. Methods: We retrospectively reviewed 100 patients who presented with a chief complaint of aural fullness from 2021 to 2025. All patients underwent microscopic and/or micro/endoscopic otologic evaluation and were subsequently treated with outpatient otologic procedures. These procedures ranged from simple cerumen removal for CI cases to aural toilettage of the external auditory canal for KO and initial debridement attempts for EACC. Results: Among 100 patients, 87 were diagnosed with CI, 10 were diagnosed with KO, and 3 were diagnosed with EACC. In 97 patients, outpatient microscopic management was effective and successful, leading to the complete removal of the underlying condition and resolution of the ear fullness. In the remaining 3 cases—all diagnosed with EACC—microscopic outpatient debridement was not sufficient. These patients were subsequently scheduled for surgical intervention following audiological and temporal bone CT evaluations. Conclusions: Our findings confirm that CI is the most frequent cause of aural fullness and that microscopic outpatient removal represents an excellent standard of care. However, clinicians should remain aware that KO and EACC may present similar symptoms. Their management is often more complex, potentially requiring multiple sessions and, in the case of EACC, can necessitate surgical intervention. Accurate diagnosis is, therefore, essential to ensure effective and appropriate treatment.