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Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm

Piergabriele Fichera1, Luca Bruschini1, Stefano Berrettini1

  • 1Department of Surgical Pathology, Medical, Molecular and Critical Area, ENT Section, Pisa University Hospital, Via Paradisa, 2, 56126 Pisa, Italy.

Audiology Research
|November 21, 2023
PubMed

Insights

Facial paralysis, a rare complication of acute otitis media (AOM), often resolves with conservative antibiotic and corticosteroid treatment. Surgical intervention is reserved for severe or unresponsive cases.

Area of Science:

  • Otolaryngology
  • Pediatric Infectious Diseases
  • Neurology

Background:

  • Acute otitis media (AOM) is a common childhood ENT infection.
  • Facial paralysis is a rare but serious complication of AOM, occurring in 0.004-0.005% of cases.
  • Prompt recognition and management are crucial to prevent long-term sequelae.

Purpose of the Study:

  • To provide a management guide for AOM-related facial paralysis.
  • To review current literature on the diagnosis and treatment of this rare complication.

Main Methods:

  • Systematic review of 15 studies published between 2000 and 2022.
  • Analysis of data from 120 pediatric patients (average age 4.96 years).
  • Evaluation of paralysis severity (House-Brackmann score) and treatment outcomes.

Main Results:

  • Facial paralysis in AOM is typically severe at onset (mean HB score 4.68) but shows high recovery rates (88.49% HB 1).
  • First-line treatment includes antibiotics (penicillins, cephalosporins) and often corticosteroids.
  • Myringotomy is indicated for intact tympanic membranes; surgery is reserved for worsening symptoms.

Conclusions:

  • Conservative management with antibiotics and corticosteroids is generally sufficient for recovery.
  • Mastoidectomy is indicated for acute mastoiditis unresponsive to conservative treatment.
  • Further research is needed on corticosteroids and surgical decompression for facial nerve recovery.

Keywords:
AOMacute otitis mediafacial palsyfacial paralysismiddle ear inflammationpediatric facial palsy

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