Facial nerve baroparesis during airflight: a case report and literature review

Abstract

Background Facial nerve baroparesis is a rare phenomenon which has been reported during flight. It is thought to occur due to ischaemic neuropraxia on the facial nerve as middle-ear pressure increases in the presence of Eustachian tube dysfunction and force is transmitted through a dehiscent facial nerve canal. Method This study presents an aviation-associated, right-sided facial nerve palsy as well as presenting the results of a systematic review that was performed on the available literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text articles from Medline, PubMed and Embase were used, as well as associated reference lists. This study systematically reviews the literature to discuss presentation, investigations performed and an approach to management of this rare condition. Results This study identified 23 cases in the literature (including the case presented in this study) of facial nerve baroparesis. Conclusion Facial nerve baroparesis is a mostly temporary rare phenomenon that can be managed effectively with ventilation tube insertion. In the event of long-standing facial nerve palsy after descent of the aircraft, urgent myringotomy should be performed to prevent permanent facial nerve damage.

An Effective Treatment for Recurrent Bilateral Facial Palsy in a Flight Attendant: A Case Report

“…The prevailing hypothesis in the literature attributes facial baroparesis to ischemic neuropraxia, based on the rapid onset and resolution of symptoms. It is theorized that excessive pressure transmitted through a dehiscence in the facial nerve canal reduces blood flow to the vasa nervorum of the facial nerve, resulting in neuropraxia [ 5 ]. Our case supports the theory, as she presented with symptoms of a dysfunctional Eustachian tube; her CT scan also revealed that bilateral tympanic segments of her facial canal were dehiscent.…”

“…She reported bilateral alternating facial nerve palsy on different occasions. Out of the 23 reported cases of facial baroparesis in aviation, 21 reported unilateral facial nerve palsy and only one reported a bilateral occurrence on two separate occasions, with the remaining case not specifying which side was affected [ 5 ]. Medical interventions were administered to a total of 13 cases.…”

“…The remaining 10 cases resolved spontaneously, requiring no medical intervention. All cases that received medical intervention reported successful outcomes [ 2 - 5 ]. In our case, we performed bilateral Eustachian tube balloon dilatation and myringotomy with grommet insertion.…”

“…This occurrence is presumed to be the result of increased middle-ear pressure with concurrent Eustachian tube dysfunction in the setting of a dehiscent facial canal wall. The pathophysiology of recurrent facial baroparesis is not fully understood, but the dehiscent facial canal wall in affected patients may expose the nerve to increased middle-ear pressure, causing transient ischemic neuropraxia [ 1 - 5 ]. We present a case of an airline stewardess with recurrent facial baroparesis, which was successfully treated with bilateral Eustachian tube balloon dilation, followed by bilateral myringotomy and Shepard grommet insertion.…”

Barotrauma inducido por vuelo en otorrinolaringología: Una revisión de la literatura

“…Su incidencia no ha sido reportada en estudios epidemiológicos, probablemente por ser una condición clásicamente autolimitada. La evidencia sobre esta patología proviene, principalmente, de reportes de casos y revisiones literarias [16][17][18] . En estos estudios se han observado más casos durante el ascenso, con edad media de presentación de 36 años, predominancia del sexo masculino y antecedente de múltiples episodios en la mayor parte de los sujetos 18 .…”