Differential diagnosis, investigations and treatment
The anamnesis revealed that the patient was affected by oral lichen planus, developed after a mourning occurred 12 months before, and no other relevant comorbidities. In the suspect of otic LP, we performed a biopsy of the EAC tissue, under local anaesthesia. The histopathologic examination confirmed the diagnosis of lichen planus of the EAC (Fig. 3). Furthermore, we submitted the patient to a computed tomography (CT) of the temporal bone. The Imaging revealed an important amount of isodense soft tissue occupying bilaterally the EAC and the whole middle ear (Fig. 4).
In order to treat the otic dermatologic manifestations, we prescribed an otologic topic therapy with ciprofloxacin-dexamethasone drops (3 mg/1mg/ml 5 drops in both ears, once a day for 3 months).
Further, in order to improve hearing results, we proposed a bone anchored hearing device (BAHD) implantation surgery. We did not propose a cochlear implant procedure for the age of the patient and for the middle ear involvement by the inflammatory disease. After a complete preoperatory counselling and a test whit the bone conduction softband device, the patient gave her informed consent to the procedure. Left side was chosen because of patient subjective preference. During the device test on softband, indeed, no significant objective differences were noticeable between left and right side at free field audiometry or open set perception evaluation. We implanted the device abutment, and after one month, we activated and fitted the device.
Considering the patient’s bone conductive hearing threshold, we proposed the most powerful hearing processor that was available on the market, indicated for a bone conductive PTA better than 65dB.