Infective causes of facial nerve paralysis

Objective: To review the functional recovery in a cohort of patients with facial nerve paralysis (FNP) due to infective cause. Study Design: Retrospective review based on patients identified from a prospectively maintained database of patients with FNP. The case notes of identified patients were reviewed. Setting: Tertiary referral center. Patients: The patients were identified from a database of 1074 patients with FNP. One hundred twenty of the 150 patients identified as having FNP due to an infectious disease caused by herpes zoster oticus were excluded from the study. The remaining 30 patients were included in the study. Interventions: Patients were treated both operatively and nonoperatively. Operative treatment included myringotomy and ventilation tube placement, cortical mastoidectomy, modified radical (canal wall down) mastoidectomy, petrous apicectomy, and lateral temporal bone resection. Main Outcome Measures: This study used the House-Brackmann (HB) grade of facial function at 1 year after initial assessment. The patients were identified from a prospectively maintained database of all patients presenting with FNP to a single specialist otolaryngologist (G.R.C.) between June 1988 and April 2005. The database contains information including demographic details, dates of presentation, diagnostic modalities used, diagnosis, interventions, and HB grade. The patients in this series presented between August 4, 1989 and August 26, 2003. Results: Twenty-nine patients with 30 facial nerve paralyses were identified. The causes of FNP were acute otitis media (n = 10); cholesteatorna (n = 10 [acquired, 7; congenital, 3]); mastoid cavity infections (n = 2) malignant otitis externa (n = 2); noncholesteatomatous chronic suppurative otitis media (CSOM; n 2); tuberculous mastoiditis (n = 1); suppurative parotitis (n 1); and chronic granulomatosis (n = 1). The patients with noncholesteatomatous CSOM who presented sooner after the onset of facial nerve symptoms had greater facial nerve recovery when assessed using the HB grade at I year. Conclusion: FNP due to infective causes other than herpes zoster oticus is rare. Patients with noncholesteatomatous CSOM and FNP have a better outcome than those with FNP due to cholesteatoma. Patients with FNP due to acute otitis media tend to have a good prognosis without surgical decompression of the facial nerve being required.