Facial paralysis during air travel: case series and literature review

Ah‐See, Kim; Shakeel, Muhammad; Maini, Sangeeta; Hussain, S. S. M.

doi:10.1017/s0022215112001594

Cited by 16 publications

(16 citation statements)

References 14 publications

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“…However, one of these cases had other clinical findings-including other CT abnormalities and prolonged hearing loss-suggesting the presence of another causal or comorbid pathology [6,9]. Other case reports have also pointed to dehiscence of the facial canal on CT [4,11], but these cases also describe additional symptoms including vertigo, hyperacusis, and tinnitus, unlike our patient.…”

Section: Discussioncontrasting

confidence: 44%

“…Facial baroparesis is a palsy of the seventh cranial nerve (CN) resulting from increased pressure compressing the nerve along its course through the middle ear cavity. Cases of facial baroparesis have been sparsely reported, most commonly in settings of increased barotrauma, such as scuba diving [1][2][3] and high-altitude air travel [4][5][6][7][8][9][10][11]. A rare phenomenon, facial baroparesis is thought to result from ischemic neuropraxia of CN VII as it passes through the tympanic segment of the facial (Fallopian) canal.…”

Section: Introductionmentioning

confidence: 99%

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Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report

et al. 2020

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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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Section: Discussioncontrasting

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report

et al. 2020

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“…It is even rarer in aviation literature, with only 11 reported cases. [1][2][3][4][5][6][7][8] The etiology is theorized as increased pressure on the tympanic segment of the facial nerve in the facial canal. 7 An increased pressure differential between ambient pressure and middle-ear pressure is believed to cause a compression of the vasa nervorum and therefore temporary ischemia.…”

Section: Introductionmentioning

confidence: 99%

Recurrent and Progressive Facial Baroparesis on Flying Relieved by Eustachian Tube Dilation

Cheng

Kaylie

2019

Ann Otol Rhinol Laryngol

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Objectives: Facial baroparesis is a rare phenomenon of seventh cranial nerve palsy traditionally reported in divers, with only 11 cases reported in aviation so far. It is important to correctly diagnose facial baroparesis given the differential diagnosis of stroke and decompression disease and offer appropriate treatment for recurrent cases. Methods: The authors present the case of a patient with recurrent and progressive facial baroparesis treated with Eustachian tube balloon dilation. Institutional medical records were reviewed, and analysis of the current literature was performed. Results: A 37-year-old woman experienced recurrent and progressive left facial paralysis on descent from altitude on commercial airline flights, with resolution between flights. The patient flew frequently for work-related trips and for the past 7 years had noted facial paralysis that began with mild asymmetry of the face and progressed to an inability to close her left eye. She denied any otologic symptoms other than ear fullness and pressure causing left otalgia. The right side was not involved. After treatment with Eustachian tube dilation, the patient has been on numerous flights with complete resolution of symptoms. Conclusions: This study presents a rare case of facial baroparesis on commercial flight descent that resolved after left Eustachian tube dilation. Although unilateral facial palsy can be concerning for stroke, a history of ear fullness and pressure may suggest facial baroparesis instead. For recurrent and progressive cases, Eustachian tube dilation should be considered for treatment.

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“…Bell's palsy Research Foundation (BPRF) [3] categorized the etiology of this facial disorder into seven major groups as follows: idiopathic, congenital, infectious, neoplastic, trauma, herpes zoster oticus and neoplastic. Al-Shee et al [4] incriminated air travelling as one of the predisposing factors of FNP. In the pediatric population, Bell's palsy is the most common cause of FNP followed by trauma [5,6].…”

Section: Introductionmentioning

confidence: 99%

Review of Facial Nerve Palsy at a Tertiary Hospital in Maiduguri, Nigeria

Stanley¹,

Ifeanyi

Zuwera³

et al. 2016

AJHR

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Background: Facial nerve palsy is cosmetically distressing and functionally disabling, and may result from several causes, such as trauma, neoplasm, infections or genetics. Purpose: This study reviewed sociodemographic distributions, common types and causes of facial nerve palsy, and cases referred for Physiotherapy between January, 2003 and December, 2012 at a tertiary hospital in Maiduguri, Nigeria. Method: Retrospective study of facial nerve palsy was conducted at the tertiary hospital. Folders of patients diagnosed with facial nerve palsy and managed at the hospital were selected and reviewed using purposive sampling technique. Patients' information was extracted from the folders and descriptive statistics was utilized to summarize the collected data. Results: A total of 48 folders of patients with facial nerve palsy from January 2003 to December 2012 were retrieved. Age range and mean age of the patients were 3-65 years and 31.02±12.3 years respectively. Age group of 23-32 years was in majority (37.5%) and male patients were more in number (64.6%) than the females. Lower motor neuron facial nerve palsy (56.2%) predominated over upper motor neuron type. Twenty (41.7%) cases were referred for physiotherapy. Conclusion: Although facial nerve palsy from our study is not common in this sub-region, awareness campaign is needed to enlighten the public about this ailing condition.

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Facial paralysis during air travel: case series and literature review

Cited by 16 publications

References 14 publications

Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report

Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report

Recurrent and Progressive Facial Baroparesis on Flying Relieved by Eustachian Tube Dilation

Review of Facial Nerve Palsy at a Tertiary Hospital in Maiduguri, Nigeria

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