Facial schwannoma without facial paralysis

A 64-year-old man with right aural discharge presented complaining of progressive deafness. Other otological symptoms were absent and specifically there was no seventh nerve paresis. A right aural polyp was identified and biopsied. Histology showed the polyp to be a schwannoma. Subsequent temporal bone computed tomography showed expansion of the distal facial canal. At operation, the schwannoma filled the middle ear cleft and extended from the genu to the region of the stylomastoid foramen. The floor of the middle ear had been eroded, exposing the jugular bulb. Facial paresis is the usual presenting feature of a facial schwannoma, while deafness, ageusia and reduced lacrimation are variable, dependent upon the site of the lesion. The absence of facial palsy as a presenting feature is very rare and this case illustrates the need for histological examination of all abnormal aural material.