Successful Placement of a BAHA Implant in a Patient With Epidermolysis Bullosa: A Case Report and Review of the Literature.

INTRODUCTION: Epidermolysis bullosa (EB) is a spectrum of mechanobullous disorders characterized by blistering following minor trauma or traction to the skin. Hearing loss in this population is poorly described in the otolaryngology literature, and its treatment oftentimes results in external auditory canal skin irritation. CASE PRESENTATION: We present the case of a 26-year-old female with EB and mixed hearing loss unable to wear conventional hearing aids due to sequelae of the external auditory canals. An osseointegrated implant was used as other hearing aids were deemed to be too destructive of the external auditory canal skin. Management and Outcome: Our patient underwent placement of a right bone-anchored hearing aid with minimal disruption of the surrounding skin using a minimally invasive punch technique. Over 1 year of follow-up, her course was complicated by 1 simple cellulitic infection at the surgical site treated successfully with oral antibiotics. DISCUSSION: The literature regarding the otolaryngologic manifestations of EB is sparse. The otologic sequelae are particularly overlooked in the workup and management. Based on the results of this case study, it appears that an osseointegrated implant can be safely utilized to treat significant mixed or conductive hearing loss in patients with EB.

Hand rejuvenation.

Aging of the hands results from both natural processes and chronic ultraviolet light exposure. Together, these cause textural and pigmentary changes, excess skin laxity, rhytides, and soft tissue atrophy that presents as prominent bones and tendons with easily visible veins. Many options are available for the reversal of these changes. Photoaging can be improved with chemical peels and light-based treatments (such as Q-switched lasers), resurfacing lasers, intense pulsed light, and photodynamic therapy. Soft tissue atrophy can be corrected with autologous fat, nonanimal stabilized hyaluronic acid, calcium hydroxylapatite, and poly-L lactic acid injections. The literature shows that these treatments have favorable outcomes for most patients; but in order to reduce known complications, it is important to understand the proper use and limitations of each modality.