Acute otitis media-related facial nerve palsy in a child: a case report and a literary review

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.

Case of Chronic Active Epstein-Barr Virus Infection Developed Hemophagocytic Lymphohistiocytosis after COVID-19 Infection

“…EBV-infected patients can exhibit a wide spectrum of clinical courses, ranging from asymptomatic to IM to malignant diseases. Cases of EBV infection presenting with otitis media preceding facial nerve palsy, as in our case, have rarely been reported in pediatric patients [10,11]. Although the underlying mechanism remains uncertain, it has been theorized that EBV, followed by a secondary bacterial infection, might be involved in developing otitis media and mastoiditis, leading to inflammation and edema within the tympanic cavity, which in turn causes facial nerve compression resulting in facial palsy [11].…”

“…Additionally, corticosteroids for inflammation control and surgical drainage of pus can be considered based on the patient's condition. However, the efficacy of using the antiviral agent acyclovir as a treatment option is uncertain [10,11]. contributes to secondary HLH [13].…”

Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm

“…The pathophysiology of facial paralysis in the case of AOM is still unclear, and several hypotheses have been put forward. As reported by De Zinis et al in the early 2000s, FP in AOM may be the result of six different pathogenic pathways: [10] (a) the direct involvement of the facial nerve by infection through bony dehiscences or physiologic canaliculi for neurovascular connections with the middle ear; (b) fallopian canal osteitis with bone erosion and nerve involvement; (c) inflammatory edema leading to compression and secondary thrombosis of the vasa nervorum with consequential ischemia and infarction of the facial nerve; (d) reactivation of a latent neurotropic virus, for example, herpesvirus; (e) demyelination of the facial nerve caused by bacterial toxins; or (f) reduced host immunologic response.…”