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

Abstract

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.

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

“…Six patients described a single episode 4-9 and 17 patients described multiple episodes. 2,3,5,[10][11][12][13][14][15][16][17][18][19] Episodes ranged from 5 minutes to 4.5 hours in duration. One patient had a known history of facial nerve schwannoma and had previously undergone a facial nerve decompression and incomplete tumour resection two years prior to his first episode of facial nerve baroparesis.…”

“…Five patients were treated with grommet insertion alone, 15,16,18 one was treated with grommet insertion coupled with nasal septum submucous resection and inferior turbinate trimming, 17 three patients were managed with nasal decongestant spray prior to flying 3,5 and one patient was treated with Eustachian tube balloon dilatation. 10 The patient with previously known facial nerve schwannoma underwent a revision facial nerve decompression with subsequent normalisation of symptoms. 11 One patient was offered grommet insertion but declined treatment.…”

“…Six patients described a single episode 4–9 and 17 patients described multiple episodes. 2,3,5,10–19…”

“…Two patients experienced vertigo during their episodes, and one patient described residual facial pain which persisted for several hours. Nine patients were investigated with CT alone, 4,5,9,10,14,15 three with magnetic resonance imaging (MRI) alone, 3,8,13 and five patients had both MRI and CT. 6,11,12,15 Two patients were investigated with skull and maxillary sinus X-rays. 2 One patient did not undergo imaging investigation 7 and imaging was not reported in three cases.…”

A Systematic Review of Eustachian Tube Procedures for Baro‐challenge Eustachian Tube Dysfunction

“…BCETD is distinct from DETD; symptoms occur only with changes in ambient pressure, leading to otalgia or a sense of aural fullness 1,2 . Rarely, patients can experience sensorineural hearing loss, persistent vertigo, facial palsy, and barotrauma 1,2,7–10 . Patients with BCETD have normal otoscopic exams at ambient pressure; therefore, BCETD is diagnosed from patient history.…”