Acute Otitis Media and Facial Nerve Paralysis in Adults Luca O. Redaelli de Zinis, Paolo Gamba, and Cristiano Balzanelli Department of Otorhinolaryngology, University of Brescia, Italy Objective: The pathophysiology and treatment of facial nerve paralysis associated with acute otitis media are still under debate. The objective of this study was to review treatment strategies and extent of recovery in adult patients with the aim of defining a standard treatment protocol for this rare patho- logic condition. Study Design: Retrospective chart review. Setting: University hospital, tertiary referral center. Patients: Between 1993 and 2000, 11 patients were admitted for facial nerve paralysis secondary to acute otitis media. There were six women and five men without a history of chronic middle ear disease, who ranged in age from 21 to 71 years. Facial palsy was graded with the House-Brackmann scale: four patients had Grade III palsy, six had Grade IV palsy, and one patient had Grade V palsy. Bacteriologic examination of middle ear fluid was performed in four patients: Streptococcus pneumoniae was observed in one patient, and the remaining three cultures were negative. Interventions: All patients were treated with parenteral ampi- cillin-sulbactam or a third-generation cephalosporin in con- junction with oral or intravenous corticosteroids, except in a single patient with diabetes mellitus who received antibiotics alone. Myringotomy alone or with ventilation tube application was performed in eight patients. A simple mastoidectomy with- out facial nerve decompression was used in a patient with sud- den impairment to Grade VI paralysis and worsening otitis after an initial improvement. Results: Normal facial function returned in all patients, inde- pendently of the grade of the paralysis, the treatment strategy, or the outcome of the middle ear disease. The time of recovery varied from 2 weeks to 3 months, except for one patient who underwent mastoidectomy and in whom normal function re- turned in 10 months. Conclusions: The treatment of facial nerve paralysis secondary to otitis media should be as conservative as possible, using antibiotics and corticosteroids. Myringotomy and a ventilation tube should be added when spontaneous perforation of the tym- panic membrane is not present. Mastoidectomy should be per- formed only when it is necessary to treat otitis media. Facial nerve decompression should not be necessary. Key Words: Otitis media—Facial paralysis. Otol Neurotol 24:113–117, 2003. Facial nerve paralysis secondary to acute otitis media (AOM) has become rare since the routine introduction of antibiotics. In Copenhagen County, the incidence of fa- cial nerve paralysis during AOM is 0.04% among adults (1), and in the past 20 years, only a few reports have been published regarding this clinical entity (1–4). To date, there is no general consensus on its pathophysiology, and suggestions for treatment are gathered from personal ex- perience or from outdated reports, which were published before the routine introduction of antibiotics. Most of the more recent reports have involved children because they are more frequently subject to AOM (5–14). Nonethe- less, the incidence of facial palsy in children with AOM is considered to be 10 times lower than in adults (1). Herein, we report the clinical data of all adult patients observed and treated at our institution for this rare patho- logic condition. Importantly, despite the previously re- ported uncertainty of the pathogenesis and the diverse treatments used, all patients were cured of facial paraly- sis, confirming the benign nature of this disease. METHODS All charts of patients admitted to the Department of Otolar- yngology of the University of Brescia, Italy, between 1993 and 1999 were reviewed to identify those patients having facial nerve paralysis during an episode of AOM. A summary of the most important features of the patients is presented in Table 1. CASE REPORTS Case 1 A 21-year-old woman was treated by her family phy- sician for right AOM with ceftriaxone, 1 g/day. After 5 days of treatment, she experienced right facial paresis and came to our department the next day. Clinical ex- amination revealed a thickened reddish right eardrum with slight asymmetry of the face at rest, incomplete closure of the right eye, and asymmetry of the mouth at Address correspondence and reprint requests to Dr. Luca Oscar Redaelli de Zinis, Department of Otorhinolaryngology, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; e-mail: redaelli@master.cci.unibs.it Otology & Neurotology 24:113–117 © 2003, Otology & Neurotology, Inc. 113