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Facial Paralysis with Ear Disease

Facial nerve dysfunction can be seen in patients who suffer from acute and chronic ear infections (otitis media). There are a number of ways that the facial nerve can be affected, and usually the time course of onset and the duration of the facial nerve dysfunction are indicators of the state of the nerve and the likelihood of full recovery.

Facial paralysis that occurs suddenly during an acute ear infection implies inflammation of the nerve, leading to a blockage of neural impulses (neurapraxia). This tends to occur in infants and young children, because the bony canal surrounding the nerve is not as insulated from the middle ear space as it is in adults. Ordinarily, prompt treatment of the infection, that sometimes includes putting a hole in the ear drum to remove the infected contents, leads to recovery of the nerve.

Facial paralysis or paresis (partial paralysis) immediately following ear surgery can be related to one of several things.

  1. The administration of local anesthetic can cause a temporary paralysis, lasting for several hours after the procedure.

  2. The thorough removal of all diseased tissue in middle ear and mastoid surgery can sometimes necessitate exposing a segment of the facial nerve in its bony canal. This exposure can result in temporary nerve inflammation which can lead to transient facial nerve paralysis. This type of injury generally recovers over weeks to months.

  3. It is possible to inadvertently nick, bruise, or divide the facial nerve during middle ear and mastoid surgery. This is characterized by immediate, complete paralysis that does not recover. If the injury was not recognized during the operation, sometimes re-exploration for assessment of the extent of injury, and possible decompression, repair, or grafting is warranted.

Sudden facial paralysis in the setting of chronic ear disease suggests damage caused by expanding chronic infection. Pressure on the nerve can occur if the disease affects and wears away bone, as is seen with cholesteatoma. When sudden facial paralysis occurs in the face of known chronic ear disease, prompt surgical exploration with evacuation of disease and nerve decompression usually results in good recovery of function.



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Illustration by Robert J. Galla of Decompression Surgery

Illustration by Robert J. Galla