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Castellazzi ML, Torretta S, Pietro GMD, Ciabatta A, Capaccio P, Caschera L, Marchisio P. Acute otitis media-related facial nerve palsy in a child: a case report and a literary review. Ital J Pediatr 2023; 49:8. [PMID: 36641446 PMCID: PMC9840536 DOI: 10.1186/s13052-022-01405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Acute otitis media has become a rare cause of facial palsy in children. A high index of suspicion is essential to achieve the diagnosis and to properly treat this condition to avoid permanent neurological sequelae. CASE PRESENTATION A case of acute otitis media-related facial nerve palsy in an 18 months-old child is described and a review of the recent literature about the clinical presentation, diagnosis, and management of this condition is performed. CONCLUSIONS Facial paralysis is an uncommon complication of acute otitis media that requires appropriate care. As highlighted in our report, the treatment of facial nerve palsy secondary to otitis media should be conservative, using antibiotics and corticosteroids. The role of antiviral is still a matter of debate. Myringotomy and a ventilation tube should be added when spontaneous perforation of the tympanic membrane is not present. More aggressive surgical approach should be considered only when there is no significant improvement.
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Affiliation(s)
- Massimo Luca Castellazzi
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Emergency Department, Via Commenda 9, 20122 Milan, Italy
| | - Sara Torretta
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Specialistic Surgical Sciences, University of Milan, Milan, Italy
| | - Giada Maria Di Pietro
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy
| | - Annaclara Ciabatta
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pasquale Capaccio
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Luca Caschera
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Neuroradiology Unit, Milan, Italy
| | - Paola Marchisio
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Wang Y, Cruz CD, Stern BJ. Approach to Facial Weakness. Semin Neurol 2021; 41:673-685. [PMID: 34826871 DOI: 10.1055/s-0041-1726358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Facial palsy is a common neurologic concern and is the most common cranial neuropathy. The facial nerve contains motor, parasympathetic, and special sensory functions. The most common form of facial palsy is idiopathic (Bell's palsy). A classic presentation requires no further diagnostic measures, and generally improves with a course of corticosteroid and antiviral therapy. If the presentation is atypical, or concerning features are present, additional studies such as brain imaging and cerebrospinal fluid analysis may be indicated. Many conditions may present with facial weakness, either in isolation or with other neurologic signs (e.g., multiple cranial neuropathies). The most important ones to recognize include infections (Ramsay-Hunt syndrome associated with herpes zoster oticus, Lyme neuroborreliosis, and complications of otitis media and mastoiditis), inflammatory (demyelination, sarcoidosis, Miller-Fisher variant of Guillain-Barré syndrome), and neoplastic. No matter the cause, individuals may be at risk for corneal injury, and, if so, should have appropriate eye protection. Synkinesis may be a bothersome residual phenomenon in some individuals, but it has a variety of treatment options including neuromuscular re-education and rehabilitation, botulinum toxin chemodenervation, and surgical intervention.
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Affiliation(s)
- Yujie Wang
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Camilo Diaz Cruz
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Barney J Stern
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
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Management of infective complications of otitis media in resource-constrained settings. Curr Opin Otolaryngol Head Neck Surg 2021; 28:174-181. [PMID: 32332206 DOI: 10.1097/moo.0000000000000627] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Complications of otitis media are a cause of significant morbidity and mortality, compounded in resource-constrained settings in which human and physical resources to manage disease are suboptimal. Here, we examine the current best evidence to devise a protocol for management, in particular exploring the opportunity for conservative or nonspecialist management. RECENT FINDINGS Reviews of the literature suggest that intratemporal and extracranial infections can be managed with antibiotics in the first instance, with aspiration or incision and drainage of abscess. Failure to respond necessitates mastoidectomy, which need not be extensive, and can be performed with hammer and gouge. Suspected or possible intracranial extension requires referral for computed tomography (CT) imaging. Intracranial infection can in some instances be managed with antibiotics, but large or persistent intracranial abscess, or the presence of cholesteatoma requires management in a centre for specialist surgery. SUMMARY Many complications of otitis media could be managed by nonspecialists in appropriately equipped local or regional health facilities, and supported by appropriate training. However, regional centres with CT imaging and specialist surgery are required for assessment and treatment of cases that are suspected of having complex or advanced disease, or that fail to respond to initial treatment. Those involved in planning healthcare provision should look to develop infrastructure to support such management.
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Abstract
Facial paralysis is a devastating condition, encompassing a spectrum of disorders, with resultant psychosocial, functional, and aesthetic sequelae. With this in mind, an individualized treatment approach based on the cause, pattern, and duration of palsy is necessary. Treatment options include pharmacologic agents, corneal protective interventions, physical therapy, and surgical procedures. The use of steroids and antivirals in the setting of idiopathic facial paralysis or virus-associated facial paralysis is well supported. Despite the diversity of surgical interventions described, there is a lack of consensus regarding optimal treatment. This article provides an overview of the current management of facial paralysis. Medical, surgical, and physical treatment options are discussed with a review of the relevant literature.
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Affiliation(s)
- Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Babak Azizzadeh
- Department of Facial Plastic & Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California
- Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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An intact bony tympanic facial canal does not protect from secondary facial paresis in adult acute otitis media. The Journal of Laryngology & Otology 2020; 134:409-414. [PMID: 32425144 DOI: 10.1017/s0022215120000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the prevalence of bony dehiscence in the tympanic facial canal in patients with acute otitis media with facial paresis compared to those without facial paresis. METHOD A retrospective case-control study was conducted on acute otitis media patients with facial paresis undergoing high-resolution temporal bone computed tomography. RESULTS Forty-eight patients were included (24 per group). Definitive determination of the presence of a bony dehiscence was possible in 44 out of 48 patients (91.7 per cent). Prevalence of bony dehiscence in acute otitis media patients with facial paresis was not different from that in acute otitis media patients without facial paresis (p = 0.21). Presence of a bony dehiscence was associated with a positive predictive value of 66.7 per cent in regard to development of facial paresis. However, an intact bony tympanic facial canal did not prevent facial paresis in 44.8 per cent of cases (95 per cent confidence interval = 34.6-55.6). CONCLUSION Prevalence of bony dehiscence in acute otitis media patients with facial paresis did not differ from that in acute otitis media patients without facial paresis. An intact tympanic bony facial canal does not protect from facial paresis development.
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Li Q, Jia Y, Feng Q, Tang B, Luo X, Xu P, Wang D, Zhang X. Analysis on outcomes of facial paralysis complicated by middle ear cholesteatoma. Acta Otolaryngol 2019; 139:211-213. [PMID: 30762460 DOI: 10.1080/00016489.2018.1543951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The prognostic factors of facial paralysis complicated by middle ear cholesteatoma (MEC) are largely unknown due to limited reports and smaller sample size. OBJECTIVES This study aimed to analyze prognostic factors of postoperative outcomes of facial paralysis complicated by MEC. MATERIAL AND METHODS Clinical data of 48 patients (48 ears) with facial paralysis complicated by MEC were retrospectively reviewed and analyzed. The outcomes of facial paralysis were compared between different groups. RESULTS All the eight cases (100%) with intact fallopian canal had complete recovery of facial paralysis after surgery, while only 52.5% cases (21/40 cases) with fallopian canal damage achieved good recovery, with significant difference (p < .05). For subgroup analysis of the 40 cases with damaged fallopian canal, the good recovery rate of facial paralysis in shorter duration group (≤2 months) was higher compared to longer duration group (>2 months) (81.0% versus 21.1%; p < .05). Moreover, the good recovery rate of facial paralysis in moderate facial paralysis group (grade II-IV) was higher compared to severe facial paralysis group (grade V-VI) (82.4% versus 30.4%; p < .05). CONCLUSIONS AND SIGNIFICANCE The outcomes of facial paralysis complicated by MEC were associated with fallopian canal integrity, duration and severity of facial paralysis.
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Affiliation(s)
- Qiang Li
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Yanfei Jia
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Qian Feng
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Bo Tang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiaodong Luo
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
| | - Peng Xu
- Department of Otolaryngology, Cangzhou Central Hospital, Cangzhou, China
| | - Daowen Wang
- Department of Otolaryngology Head and Neck Surgery, Peking University, Beijing, China
| | - Xuanfen Zhang
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China
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Abstract
PURPOSE OF REVIEW The aim of this study is to discuss the symptoms, diagnosis, and management of the neurologic complications of acute and chronic otitis media. RECENT FINDINGS Antibiotic therapy has greatly reduced the frequency of complications of otitis media. However, it is of vital importance to remain aware of the possible development of neurologic complications. There is a trend toward less severe presenting symptoms including otorrhea, headache, nausea, and fever, with altered mental status and focal neurologic deficits presenting later. In order to reduce morbidity, early deployment of a multidisciplinary approach with prompt imaging and laboratory studies is imperative to guide appropriate management. Complications of acute and chronic otitis media may present with neurologic signs and symptoms. It is important to recognize the possible otitic origin of such complications to ensure proper management and to decrease overall morbidity and mortality.
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Affiliation(s)
- Michael J Hutz
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA.
| | - Dennis M Moore
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
- Division of Otolaryngology - Head and Neck Surgery, Hines VA Medical Center, Hines, IL, USA
| | - Andrew J Hotaling
- Department of Otolaryngology - Head and Neck Surgery, Loyola University Medical Center, 2160 S 1st Avenue, Maywood, IL, 60153, USA
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Facial Nerve Paralysis in Acute Suppurative Otitis Media-Management. Indian J Otolaryngol Head Neck Surg 2017; 69:58-61. [PMID: 28239580 DOI: 10.1007/s12070-017-1051-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022] Open
Abstract
Facial paralysis is a rare complication of acute suppurative otitis media which requires early detection and appropriate care. We hereby report a case which we managed conservatively with good outcome. Following our experience and review of literature on the subject, antibiotic therapy and corticosteroid therapy, with or without myringotomy were found to be the first-line procedures. Surgery should be employed in case of acute or coalescent mastoiditis, suppurative complications and lack of clinical regression.
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Bluestone CD, Klein JO, Rosenfeld RM, Berman S, Casselbrant ML, Chonmaitree T, Giebink GS, Grote JJ, Ingvarsson LB, Linder T, Lous J, Maw AR, Paradise JL, Sando I, Stool SE, Takasaka T. 9. Treatment, Complications, and Sequelae. Ann Otol Rhinol Laryngol 2016. [DOI: 10.1177/00034894021110s312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Popovtzer A, Raveh E, Bahar G, Oestreicher-Kedem Y, Feinmesser R, Nageris BI. Facial palsy associated with acute otitis media. Otolaryngol Head Neck Surg 2016; 132:327-9. [PMID: 15692549 DOI: 10.1016/j.otohns.2004.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE: Facial palsy secondary to acute otitis media is rarely encountered today. The aim of the present study was to review the characteristics of the disease and propose the proper management. STUDY DESIGN: File review. SETTING: University-affiliated tertiary referral center. MAIN OUTCOME MEASURES: Disease course, management and outcome were recorded. RESULTS: Sixty-five children with facial palsy were identified, of whom 13 (20%) had acute otitis media. The otitis media preceded the facial palsy in all cases by 1 to 21 days (average 5 days). House-Brackmann grade ranged from 2 to 5 (average 3.5). The recovery period was varied and unpredictable, ranging in duration from 1 to 180 days (average 68 days). Treatment was conservative, except for insertion of a ventilation tube in 2 cases. CONCLUSIONS: Considering that all the patients recovered, conservative treatment, including myringotomy and intravenous antibiotics, may be the correct approach to facial palsy associated with acute otitis media.
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Affiliation(s)
- Aron Popovtzer
- Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, ENT Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
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Maranhão A, Andrade J, Godofredo V, Matos R, Penido N. Epidemiology of intratemporal complications of otitis media. Int Arch Otorhinolaryngol 2014; 18:178-83. [PMID: 25992087 PMCID: PMC4297008 DOI: 10.1055/s-0033-1364172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 11/22/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction Despite the advent of antibiotics and immunizations in the last century, complications of otitis media remain quite frequent, have high morbidity and mortality rates, and pose a challenge to the otorhinolaryngologist. Objective To establish the annual incidence of intratemporal complications of otitis media and prospectively evaluate patients via an analysis of epidemiologic and clinical aspects. Methods Prospective, observational study. Between February 2010 and January 2011, patients admitted to a tertiary care, university-based otology practice with diagnosis of otitis media and an associated intratemporal complication (ITC) were included in the study. The following data were evaluated: age, sex, type of ITC, treatment, imaging tests findings, type and degree of hearing loss, and clinical outcome. The overall incidence of all complications and of each complication individually was determined. Results A total of 1,816 patients were diagnosed with otitis media. For 592 (33%) individuals, the diagnosis was chronic otitis media; for 1,224 (67%), the diagnosis was acute otitis media. ITCs of otitis media were diagnosed in 15 patients; thus, the annual incidence of intratemporal complications was 0.8%. We identified 19 ITC diagnoses in 15 patients (3 patients had more than one diagnosis). Labyrinthine fistulae were diagnosed in 7 (36.8%) individuals, mastoiditis in 5 (26.3%), facial palsy in 4 (21.1%), and labyrinthitis in 3 (15.8%). Conclusion The incidence of intratemporal complications in Brazil remains significant when compared with developed countries. Chronic otitis media with cholesteatoma is the most frequent etiology of intratemporal complications. Labyrinthine fistula is the most common intratemporal complication.
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Affiliation(s)
- André Maranhão
- Department of Otolaryngology, Universidade Federal de São Paulo - UNIFESP, Rua Dos Otonis, Sao Paulo, Brazil
| | - José Andrade
- Department of Otolaryngology, Universidade Federal de São Paulo - UNIFESP, Rua Dos Otonis, Sao Paulo, Brazil
| | - Valéria Godofredo
- Department of Otolaryngology, Universidade Federal de São Paulo - UNIFESP, Rua Dos Otonis, Sao Paulo, Brazil
| | - Rafaela Matos
- Department of Otolaryngology, Universidade Federal de São Paulo - UNIFESP, Rua Dos Otonis, Sao Paulo, Brazil
| | - Norma Penido
- Department of Otolaryngology, Universidade Federal de São Paulo - UNIFESP, Rua Dos Otonis, Sao Paulo, Brazil
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Tsai TC, Yu PM, Tang RB, Wang HK, Chang KC. Otorrhea as a sign of medical treatment failure in acute otitis media: two cases with silent mastoiditis complicated with facial palsy. Pediatr Neonatol 2013; 54:335-8. [PMID: 23602239 DOI: 10.1016/j.pedneo.2013.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 03/14/2012] [Accepted: 03/26/2012] [Indexed: 10/26/2022] Open
Abstract
We report two children with otitis media who developed facial palsy despite prompt antibiotic therapy. Brain images revealed silent mastoiditis. Persistent otorrhea may be a cautious sign of medical treatment failure or complication of acute otitis media, including mastoiditis or facial palsy. Delayed identification of coexisting mastoiditis or hesitation over surgical intervention may lead to treatment failure and complications. Adequate intravenous antibiotics and myringotomy provide reasonable and appropriate management to prevent permanent sequelae.
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Affiliation(s)
- Tzu-Chun Tsai
- Department of Pediatrics and Otorhinolaryngology, National Yang-Ming University Hospital, Yilan, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
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Maranhão ASDA, Andrade JSCD, Godofredo VR, Matos RC, Penido NDO. Intratemporal complications of otitis media. Braz J Otorhinolaryngol 2013; 79:141-9. [PMID: 23670317 PMCID: PMC9443832 DOI: 10.5935/1808-8694.20130026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 01/13/2013] [Indexed: 11/20/2022] Open
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Kim J, Jung GH, Park SY, Lee WS. Facial nerve paralysis due to chronic otitis media: prognosis in restoration of facial function after surgical intervention. Yonsei Med J 2012; 53:642-8. [PMID: 22477011 PMCID: PMC3343423 DOI: 10.3349/ymj.2012.53.3.642] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. MATERIALS AND METHODS A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. RESULTS Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. CONCLUSION COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM.
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Affiliation(s)
- Jin Kim
- Department of Otorhinolaryngology, Inje University College of Medicine, Goyang, Korea
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Abstract
Facial nerve paralysis (FNP) is a very rare complication of otitis media with effusion (OME). There are few patients with OME and FNP in the literature. A 5-year-old girl was admitted to our department with right facial weakness. Right FNP and right OME were diagnosed on the examination. After medical treatment and ventilation tube insertion, FNP completely resolved. The symptoms, signs, and management of this patient are presented.
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Abstract
Facial nerve palsy has a broad differential diagnosis and possible psychological and anatomical consequences. A thorough investigation must be performed to determine the cause of the palsy and to direct treatment. If no cause can be found, therapy with prednisone with or without an antiviral medication can be considered and begun as early as possible after onset of symptoms. Resolution and time to recovery vary with etiology, but overall prognosis is good.
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Abstract
OBJECTIVE To describe the characteristics of children who present to an emergency department (ED) with facial palsy and determine the association of outcome with etiology, degree of initial paralysis, and ED management. METHODS This was a retrospective cohort study of children who presented to an ED with facial nerve paralysis (FNP). RESULTS There were 85 patients with a mean age of 8.0 (SD, 6.1) years; 60% (n = 51) of the patients were male, and 65.9% (n = 56) were admitted to the hospital. Bell palsy (50.6%) was the most common etiology followed by infectious (22.4%), traumatic (16.5%), congenital (7.1%), and neoplastic etiologies (3.5%). Patients with Bell palsy had shorter recovery times (P = 0.049), and traumatic cases required a longer time for recovery (P = 0.016). Acute otitis media (AOM)-related pediatric FNP had shorter recovery times than non-AOM-related cases (P = 0.005) in infectious group. Patients given steroid therapy did not have a shorter recovery time (P = 0.237) or a better recovery (P = 0.269). There was no difference in recovery rate of pediatric patients with Bell palsy between hospitalization or not (P = 0.952). CONCLUSION Bell palsy, infection, and trauma were most common etiologies of pediatric FNP. Recovery times were shorter in pediatric patients with Bell palsy and AOM-related FNP, whereas recovery took longer in traumatic cases. Steroid therapy did not seem beneficial for pediatric FNP. Hospitalization is not indicated for pediatric patients with Bell palsy.
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Yonamine FK, Tuma J, Silva RFND, Soares MCM, Testa JRG. Facial paralysis associated with acute otitis media. Braz J Otorhinolaryngol 2009; 75:228-30. [PMID: 19575108 PMCID: PMC9450600 DOI: 10.1016/s1808-8694(15)30782-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 11/10/2007] [Indexed: 10/27/2022] Open
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Inner ear and facial nerve complications of acute otitis media, including vertigo. Curr Allergy Asthma Rep 2008; 7:444-50. [PMID: 17986375 DOI: 10.1007/s11882-007-0068-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Acute otitis media is one of the most common diagnoses made in children in the United States. Intracranial and extracranial (intratemporal) complications have greatly decreased in the antibiotic era, but still remain a challenge when they arise. This article addresses two intratemporal complications with significant associated morbidity: facial nerve paralysis/paresis, and labyrinthitis. Epidemiology, pathology, clinical diagnosis, and treatment options are discussed, focusing on an evidence-based approach to diagnosis and management. In addition, the future of treatment and current questions regarding otitis media are briefly discussed.
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Abstract
OBJECTIVES To establish the incidence, current treatment and outcome of adult patients with acute intratemporal and intracranial complications of otitis media (OM). DESIGN A retrospective chart review with a sent questionnaire. SETTING Tertiary referral centre, University hospital. PARTICIPANTS Adult patients treated for acute intratemporal and intracranial complications of OM over the past 15 years (1990-2004) in the study hospital. MAIN OUTCOME MEASURES Incidence, treatment and outcome of patients with intratemporal and intracranial complications of OM. RESULTS Fifty patients aged 16-75 years were treated. The annual age-adjusted incidence of acute intratemporal and intracranial complications was 0.32/100 000. Forty-one (82%) of the complications were intratemporal and nine (18%) were intracranial. The ear disease behind the acute complication was acute otitis media (AOM) in 80% (40/50), chronic otitis media (COM) in 12% (6/50) and COM with cholesteatoma in 8% (4/50). Mastoiditis was complicated by subperiosteal abscess, labyrinthitis and facial paresis in 7% (3/41), 15% (6/41) and 32% (13/41) respectively. Mastoidectomy was performed on 56% (28/50) of the patients. Four (44%) of the intracranial complications were intracranial abscesses, four (44%) were meningitis and one (11%) was sinus thrombosis. Permanent hearing loss occurred in 13 (26%) patients and one patient died due to otogenic meningitis. CONCLUSIONS Severe complications of the OM in adults are rare in Finland. The commonest cause is AOM rather than COM. Operative treatment is predominantly needed for intracranial complications and intratemporal abscesses. Complications of OM are still associated with considerable morbidity, and early recognition is most likely to form the basis for effective treatment.
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Affiliation(s)
- K Leskinen
- Department of Otolaryngology, Helsinki University Central Hospital, Haartmaninkatu 4E, PO Box 220, FIN-00029 HUCH, Helsinki, Finland.
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Abstract
The clinical picture and the treatment of acute otitis media (AOM) and its complications have changed during the past decades. The availability of antibiotics has decreased the incidence of complications of AOM significantly. The treatment of complications of AOM is conservative in most cases. Mastoidectomy is needed when abscess-forming mastoiditis or intracranial complications develop. Although intratemporal and intracranial complications of AOM are rare today, they still cause morbidity, and need prompt treatment. Occasionally, permanent damage of the ear leads to hearing loss, vertigo, and sometimes, facial weakness. Antibiotic treatment has decreased the mortality associated with the complications of AOM, but it is still high in countries with developing health care systems. Early diagnosis and effective treatment of the complications are the bases for a good prognosis.
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Affiliation(s)
- Kimmo Leskinen
- Department of Otolaryngology, Helsinki University Central Hospital, Haartmaninkatu 4 E, PO Box 220, FIN-00029 Huch, Finland.
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Kuczkowski J, Mikaszewski B, Narozny W. Intratemporal complications of acute otitis media in children. J Paediatr Child Health 2005; 41:231; author reply 231-2. [PMID: 15813883 DOI: 10.1111/j.1440-1754.2005.595_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gaio E, Marioni G, de Filippis C, Tregnaghi A, Caltran S, Staffieri A. Facial nerve paralysis secondary to acute otitis media in infants and children. J Paediatr Child Health 2004; 40:483-6. [PMID: 15265194 DOI: 10.1111/j.1440-1754.2004.00436.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nowadays, facial paralysis is an uncommon complication of acute inflammation of the middle ear, with an estimated incidence of 0.005%; it was not so rare in the pre-antibiotic era, occurring in 0.5-0.7% of middle ear inflammatory processes. We would like to highlight this complication of acute otitis media, a common paediatric complaint. We present three new cases of facial palsy in children with acute otitis media and discuss the etiological mechanisms and different approaches to the treatment; a flow chart for facial paralysis in acute otitis media is also presented. Our three patients recovered completely after mastoidectomy (first two cases) and myringotomy with antibiotic therapy (third case). Facial paralysis is an uncommon complication of otitis media which requires appropriate care. Following our experience and revision of literature on the subject, antibiotic therapy and myringotomy are the first-line procedures. Surgery should be employed in case of acute or coalescent mastoiditis, suppurative complications and lack of clinical regression.
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Affiliation(s)
- E Gaio
- Department of Otolaryngology-Head and Neck Surgery, University of Padua, Italy.
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Abstract
BACKGROUND The incidence of intratemporal and intracranial complications of acute otitis media (AOM) has decreased and the need for operative treatment is declined in developed countries during the antibiotic era. OBJECTIVES To establish the clinical picture, diagnostic procedures, outcome and current treatment of pediatric patients with intratemporal and intracranial complications of AOM. METHODS A retrospective chart review with a sent questionnaire. All pediatric patients treated for intratemporal and intracranial complications of AOM over the past 10 years (1990-2000) at the Department of Otolaryngology in the Helsinki University Central Hospital. RESULTS During the study period 33 children (incidence 1.1/100,000 per year), aged from 3 months to 14.2 years were treated for intratemporal [97% (32/33)] and intracranial [3% (1/33)] complications of AOM. Facial paresis was found in 9% (3/33) of the patients. The only intracranial complication was an extradural abscess with meningitis. Eighteen patients (55%) were on antibiotic treatment because of AOM prior to the diagnosis of complication. Neither the duration or severity of the signs and symptoms of infection at the time of admittance nor a lack of antibiotic treatment before admittance were statistically significantly associated with the need for mastoidectomy or duration of hospitalization. Streptococcus pneumoniae 25% (8/33) and Pseudomonas aeruginosa 22% (7/33) were the most frequently found bacteria in the culture of middle ear and mastoid effusions. Mastoidectomy was performed on 55% (18/33) of the patients. After half a year of follow-up, all the patients had normal hearing and facial function. CONCLUSIONS Severe complications of AOM are rare today in southern Finland and the need for mastoidectomy has declined significantly. With early recognition and effective treatment of complications, the prognosis is good.
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Affiliation(s)
- Kimmo Leskinen
- Department of Otolaryngology, Helsinki University Central Hospital, Haartmaninkatu 4E, PO Box 220, Helsinki, FIN-00029 HUCH, Finland.
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Abstract
OBJECTIVE The pathophysiology and treatment of facial nerve paralysis associated with acute otitis media are still under debate. The objective of this study was to review treatment strategies and extent of recovery in adult patients with the aim of defining a standard treatment protocol for this rare pathologic condition. STUDY DESIGN Retrospective chart review. SETTING University hospital, tertiary referral center. PATIENTS Between 1993 and 2000, 11 patients were admitted for facial nerve paralysis secondary to acute otitis media. There were six women and five men without a history of chronic middle ear disease, who ranged in age from 21 to 71 years. Facial palsy was graded with the House-Brackmann scale: four patients had Grade III palsy, six had Grade IV palsy, and one patient had Grade V palsy. Bacteriologic examination of middle ear fluid was performed in four patients Streptococcus pneumoniae was observed in one patient, and the remaining three cultures were negative. INTERVENTIONS All patients were treated with parenteral ampicillin-sulbactam or a third-generation cephalosporin in conjunction with oral or intravenous corticosteroids, except in a single patient with diabetes mellitus who received antibiotics alone. Myringotomy alone or with ventilation tube application was performed in eight patients. A simple mastoidectomy without facial nerve decompression was used in a patient with sudden impairment to Grade VI paralysis and worsening otitis after an initial improvement. RESULTS Normal facial function returned in all patients, independently of the grade of the paralysis, the treatment strategy, or the outcome of the middle ear disease. The time of recovery varied from 2 weeks to 3 months, except for one patient who underwent mastoidectomy and in whom normal function returned in 10 months. CONCLUSIONS The treatment of facial nerve paralysis secondary to otitis media should be as conservative as possible, using antibiotics and corticosteroids. Myringotomy and a ventilation tube should be added when spontaneous perforation of the tympanic membrane is not present. Mastoidectomy should be performed only when it is necessary to treat otitis media. Facial nerve decompression should not be necessary.
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Kvestad E, Kvaerner KJ, Mair IWS. Otologic facial palsy: etiology, onset, and symptom duration. Ann Otol Rhinol Laryngol 2002; 111:598-602. [PMID: 12126015 DOI: 10.1177/000348940211100706] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To estimate the occurrence of otogenic facial palsy, we performed a retrospective case record study of all patients hospitalized for otogenic facial palsy in the period 1989 to 1999 at Ullevål University Hospital, which is the only referral hospital for patients with otologic sequelae in Oslo. The facial palsy was a complication of acute otitis media in 10 patients (56%), of acute mastoiditis in 3 patients (17%), of secretory otitis media in 3 patients (17%), and of chronic otitis media in 2 patients (11%). In half of the patients, complete facial palsy was found at the time of diagnosis. Sixteen patients (89%) reported a gradual onset of the facial palsy. The mean duration of otologic symptoms before the onset of facial palsy was 3 days (range, 1 to 9 days), and the median time to remission was 9 weeks (range, 2 to 96 weeks). Total remission was achieved in all patients who received follow-up. Although most patients recover within a few weeks, some patients have long-lasting facial palsy. Multicenter studies are needed to increase the sample size and to identify predictors of facial palsy duration.
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Affiliation(s)
- Ellen Kvestad
- Department of Otorhinolaryngology, Ullevål University Hospital, Oslo, Norway
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Hostetler MA, Suara RO, Denison MR. Unilateral facial paralysis occurring in an infant with enteroviral otitis media and aseptic meningitis. J Emerg Med 2002; 22:267-71. [PMID: 11932090 DOI: 10.1016/s0736-4679(01)00483-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We report the case of a four month old infant presenting to the Emergency Department (ED) with irritability and facial asymmetry following a recent bout of gastroenteritis. Physical examination revealed a unilateral peripheral facial nerve paralysis. Common in older children and adults, facial nerve palsy has rarely been described in infancy. Although historically associated with a variety of inflammatory and infectious causes, the pathogenesis remains unclear. In this infant we were able to successfully identify an underlying acute enteroviral infection. Coxsackie B5 was isolated from the middle ear fluid, cerebrospinal fluid (CSF), nasopharyngeal and rectal swabs. After myringotomy drainage of the middle ear fluid and placement of pneumatic equalization tubes, there was rapid and complete resolution of facial paralysis.
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Affiliation(s)
- Mark A Hostetler
- Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA
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Affiliation(s)
- C D Bluestone
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, PA 15213, USA.
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Abstract
Imaging of the facial nerve has proved its usefulness to physicians in the evaluation of pathological conditions of this nerve. Magnetic resonance imaging (MRI) of the facial nerve should always be obtained selectively and should include the parotid gland in case of peripheral facial nerve palsy. Gadolinium-DTPA contrast pulse sequence is the most informative MRI study for evaluation of facial nerve pathology. This article reviews the imaging anatomy of the facial nerve and describes the clinical features and MR characteristics of common disorders of the facial nerve.
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Affiliation(s)
- A Kumar
- Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, 60612-7243, USA
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Bhattacharyya AK, Ghodh S. Current opinion in the management in acute otitis media. Indian J Otolaryngol Head Neck Surg 1998; 50:156-61. [PMID: 23119403 PMCID: PMC3451002 DOI: 10.1007/bf02991679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The management of Acute otitis media has been a subject of controversy. This paper discusses the the current opinion on the subject including a review of recent literature. The use and choice of antibiotics reflects the wide variation in opinion for both first line and second-line therapy. The role of tympanocentesis and prophylactic treatment is discussed. The introduction of vaccines holds new promise on the prevention of Acute otitis media. Factors affecting outcome influence the management plan especially in recurrent cases, high risk groups and treatment failures.
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Affiliation(s)
- A K Bhattacharyya
- St. Bartholomews and Royal London Hospitals & Medical School, London
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