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Caffrey JP, Adams JW, Costantino I, Klepper K, Kari E, Brown LA. Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report. J Med Case Rep 2020; 14:218. [PMID: 33176863 PMCID: PMC7659090 DOI: 10.1186/s13256-020-02557-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment. Case presentation A 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention. Conclusions Prompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients.
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Affiliation(s)
- Jason P Caffrey
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jason W Adams
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Center for Academic Research and Training in Anthropogeny, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Isabel Costantino
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Kristin Klepper
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Elina Kari
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of California, San Diego, 9444 Medical Center Drive, La Jolla, CA, 92037, USA
| | - Lori A Brown
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. .,Division of General Internal Medicine, Department of Medicine, University of California, San Diego, 200 West Arbor Drive, San Diego, CA, 92103-8415, USA.
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