This article is more than 5 years old. Information may no longer be current.

Otic lichen planus related to persistent hearing loss, otorrhea

Otic lichen planus was associated with persistent hearing loss and otorrhea, according to results of a recently published 10-year review.

Researchers at Mayo Clinic, Rochester, Minn., conducted a retrospective review of medical records from Jan. 1, 2001, to May 31, 2011, of patients diagnosed with otic lichen planus (LP) and identified 19 cases (mean age at diagnosis, 57 years; 15 women). LP sites included oral (n=11), vulvovaginal gingival (n=10), cutaneous (n=5), otic only (n=5) and esophageal (n=4). The mean symptom duration before diagnoses was 4 years in 13 patients. Mean duration of follow-up from initial diagnoses was 4.9 years, and the mean number of follow-up dermatology and otolaryngology visits was 13.8.

Eleven patients had bilateral disease; eight had unilateral involvement, according to examination of the ears. Fifteen patients had persistent otorrhea, and 15 had hearing loss, the most commonly occurring symptoms. Eleven patients experienced simultaneous otorrhea and hearing loss, six had plugging, and five exhibited pruritus.

Seventeen patients were treated with topical tacrolimus, with an overall good response during several months. Topical clobetasol propionate or otic ciprofloxacin hydrochloride and dexamethasone combination therapy were used to treat the other two patients. One patient with severe otic LP affecting the ear, oral cavity, esophagus and genital areas responded to rituximab.

“Otic LP … should be considered in differential diagnosis of relentless otorrhea and external auditory canal stenosis,” the researchers concluded. “Topical tacrolimus is the best primary treatment, but alternative therapies could be instituted in severe cases.

“Early recognition of the nonspecific symptoms of otic lichen planus may lead to prompt treatment and avoidance of irreparable late sequelae. Appropriate and timely referrals to a dermatologist should be made for patients with suspected mucosal lichen planus.”