Bilateral simultaneous facial nerve palsy: A rare presentation of tubercular otitis media

Background

When the facial nerve on the other side becomes affected within 30 days of the first side, it is referred to as “bilateral simultaneous facial nerve palsy.”

Case report

A 31-year-old Nepalese man with simultaneous bilateral facial nerve palsy and painful ear discharge presented to the emergency room. Ear examination revealed right bilateral myringitis and a perforation in the left ear. A pus culture was sent from the ears, and blood tests were done to exclude viral etiology. Using imaging techniques such computed tomography (CT) of the temporal bones and magnetic resonance imaging (MRI) of the brain, intracranial and intratemporal causes of the facial nerve involvement were ruled out. Suspecting tuberculous otitis media as an etiology, induced sputum and ear discharge were sent for AFB culture and TB PCR, which came back positive. Features indicative of pulmonary tuberculosis were seen on a chest CT scan. Antitubercular treatment started, and the patient followed up. Facial paralysis recovered to normal in 4 months.

Conclusion

It is uncommon to have bilateral facial nerve paralysis. Ear discharge with early facial nerve involvement should raise suspicion of tubercular otitis media, and early diagnosis and treatment will prevent further complications and can reverse the paralysis.

Other Information

Published in: Otolaryngology Case Reports
License: http://creativecommons.org/licenses/by/4.0/
See article on publisher's website: https://dx.doi.org/10.1016/j.xocr.2023.100520