Pediatric Peripheral Facial Nerve Palsy – The Role of Ear Pathology

Background: Nearly half of the acquired cases of peripheral facial nerve palsy (PFNP) are of unknown etiology, a condition then termed Bell`s palsy (BP). PFNP can be associated with acute otitis media (OM). Differences between the clinical course and prognosis in OM-associated PFNP (OM-PFNP) and BP are not well characterized.

Methods: retrospective review of all children hospitalized in a tertiary care children`s hospital during the 2006-2016 period with a diagnosis of non-traumatic and non-surgery associated PFNP.

Results: Records of 125 children with facial nerve palsy were reviewed, 33 had an underlying neurologic condition (central) and 3 had a traumatic etiology. Thus, a total of 89 cases of non traumatic PFNP were found, 50 with OM-PFNP and 39 with BP. Children with OM-PFNP were younger at presentation (39.8±53.4 Vs 113.5±73.1 months, p <0.001), presented more frequently during the autumn/winter months (64% Vs 41% of all cases) and had a higher average CRP value [median (range) CRP: 1.4 (0-26) Vs 0 (0-9.5) mg/dL, p< 0.005). There was no significant difference in the rate of use of corticosteroids (85%). Four children with OM-PFNP had an additional underlying pathology (mastoiditis, petrous bone osteomyelitis, cholesteatoma and rhabdomyosarcoma).

Conclusions: Children with OM-PFNP are younger at presentation and presented more commonly in the autumn/winter in comparison to BP. Children with OM-PFNP should be assessed for the presence of significant associated middle ear/ petrous bone pathology.