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Hemifacial spasm secondary to middle ear cholesteatoma

Maheep Sohal1, Nicholas Karter, Marc Eisen

  • 1Division of Otolaryngology-Head and Neck Surgery, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030, USA. maheep.sohal@gmail.com.

Ear, Nose, & Throat Journal
|July 24, 2018
PubMed

Insights

Hemifacial spasm, a condition affecting facial muscles, can rarely stem from middle ear issues. This case highlights successful treatment of a 90-year-old man whose spasm was caused by recurrent cholesteatoma.

Area of Science:

  • Neurology
  • Otolaryngology
  • Medical Case Study

Background:

  • Hemifacial spasm (HFS) involves involuntary contractions of facial muscles, typically due to VIIth cranial nerve irritation.
  • While often caused by vascular compression, HFS can rarely be linked to middle ear pathologies.
  • Recurrent cholesteatoma and facial nerve involvement present unique diagnostic and management challenges.

Observation:

  • A 90-year-old male presented with right-sided hemifacial spasm.
  • He had a history of middle ear cholesteatoma treated surgically six years prior.
  • Imaging revealed recurrent cholesteatoma and dehiscence of the tympanic segment of the facial canal.

Findings:

  • Middle ear exploration confirmed cholesteatoma abutting a dehiscent facial nerve.
  • Surgical dissection of the cholesteatoma and matrix preserved facial nerve function.
  • The patient's hemifacial spasm resolved postoperatively.

Implications:

  • This case highlights middle ear cholesteatoma as a treatable cause of hemifacial spasm.
  • It underscores the importance of considering otologic pathology in secondary HFS cases.
  • Successful surgical management can restore facial nerve function and alleviate spasm.

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