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Bilateral Facial Nerve Paralysis associated with Otomastoiditis: A Case Report
Author(s) -
Armin Bob B.,
Calzada Audrey,
Ishiyama Akira
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21253
Subject(s) - medicine , computer science
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the presentation and treatment of facial nerve paralysis caused by acute otomastoiditis. Objectives: Describe surgical management of facial nerve paralysis caused by acute otomastoiditis. Study Design: Case report with a literature review. Methods: A case report is described. Background, incidence, disease course, and treatment options are presented through a literature review. Results: We present the case of a 55 year old male, who presented to the emergency room with bilateral otorrhea and 2 day history of bilateral facial paralysis. CT demonstrated bilateral mastoid opacification. Examination revealed bilateral purulent otorrhea, mastoid tenderness, and complete facial nerve paralysis with symptoms more severe on the right. Intravenous and topical antibiotics and steroids were started, and bilateral ventilation tube placement was performed. Facial nerve function failed to improve after 2 weeks of directed antibiotics; therefore, a right tympanomastoidectomy was performed. By post operative day 3, some right facial nerve function was noted. On one month follow up, right facial nerve function had almost fully recovered, while the function on the left remained poor. A left tympanomastoidectomy was subsequently performed with similar significant postoperative improvement in facial nerve function. Conclusions: The treatment of otogenic facial nerve paralysis is a subject of debate with medical management currently forming the basis of treatment. However, these recommendations are greatly based on studies on pediatric cases of otitis media. We present a unique case of a patient with bilateral facial nerve paralysis, not responsive to initial conservative management, but responding to bilateral mastoidectomies. This case demonstrates the important role of surgical intervention in the management of complete facial nerve paralysis in adult patients with acute otomastoiditis. Bilateral Facial Nerve Paralysis associated with Otomastoiditis: A Case Report