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.
ASOM
Otosclerosis
Tympanosclerosis
Cholesteotoma