Otoneurology, facial palsy

OBJECTIVE: To illustrate our experience when managing a complex patient with potentially life-threatening bilateral otological disease facing multisensory compromise including complete loss of audiovestibular function and visual disturbance Clinical presentation: A 67 year old lady, presented with a large left vestibular schwannoma and extensive right cholesteatoma encircling the otic capsule. She underwent translabyrinthine resection of the vestibular schwannoma, resulting in profound sensorineural hearing loss, vestibular hypofunction and corneal scarring following an initial temporary facial palsy...

Melkersson-Rosenthal Syndrome (MRS) is a rare otoneurologic condition, which is poorly understood and often underdiagnosed. Etiology and incidence are unclear, although infectious, inflammatory, and genetic causes have been implicated. Recurrent facial nerve palsy, facial swelling, and fissured tongue are the symptoms and signs of this condition. However, this triad is not typical in all patients as patients may present with one or more of the symptoms, which makes management of this condition difficult. Steroids may prove to be useful especially in patients who have facial nerve palsy...

Sarcoidosis is an inflammatory multisystem disorder of unknown cause. Approximately 5-7% of patients manifest symptoms of central nervous system involvement, or neurosarcoidosis. Cranial neuropathy usually entails facial nerve palsy and optic neuritis. Sudden hearing loss has been reported in fewer than 20 cases. Herewith, two new cases of sudden hearing loss due to probable neurosarcoidosis are reported, each having a quite different clinical course. In one case, unilateral sudden hearing loss and facial palsy were the presenting symptoms of systemic sarcoidosis, while in the second, unilateral sudden deafness occurred despite ongoing immunosuppressive treatment for systemic sarcoidosis...

We report a case of infarction of the anterior inferior cerebellar artery (AICA) with peripheral facial palsy following vertigo and acute sensorineural hearing loss. A 39-year-old female presented with vertigo and sudden hearing loss, tinnitus, and aural fullness of the right ear. An audiogram revealed a severe hearing loss at all tested frequencies in the right ear. Spontaneous nystagmus toward the left side was also observed. Otoneurological examinations showed sensorineural hearing loss of the right ear and horizontal and rotatory gaze nystagmus toward the left side, and a caloric reflex test demonstrated canal paresis...

Non-Hodgkin diffuse large B-cell lymphomas of the mastoid that extend from the nasopharynx are extremely rare in children. Moreover, in lymphoproliferative diseases, the presence of otoneurological signs prior to systemic disease involvement is rare. Here, we present a rare case of non-Hodgkin B-cell lymphoma invading the middle ear and mastoid in a 1-year-old boy that mimicked acute mastoiditis with complete facial nerve palsy. As this case illustrates, physicians should consider a diagnosis of malignant lymphoma if a patient presents with otitis media and mastoiditis accompanied by facial palsy...

Bell's palsy or idiopathic facial palsy is the commonest cause of unilateral lower motor neuron facial palsy. Misdiagnosis of facial nerve palsy as Bell's palsy is still seen in clinical practice. The clinician should always consider the possibility of a potentially serious underlying pathology before making the diagnosis of Bell's palsy. We present a series of 13 patients referred to our ENT department with an initial diagnosis of Bell's palsy. Further clinical examination and investigation revealed the underlying cause...

OBJECTIVE: Acute facial palsy in children is believed to be a rather benign neurological condition. Follow-up-studies are sparse, especially including a thorough otoneurological re-examination. The aim of this study was to examine children with a history of facial palsy in order to register the incidence of complete recovery and the severity and nature of sequelae. We also wanted to investigate whether there was a correlation between sequelae and Lyme Borreliosis, treatment or other health problems...

A case of peripheral facial palsy revealing a recent HIV infection is reported. Facial paralysis is frequent in HIV patients. Its etiology depends on the stage of the disease. At all stages, Bell's palsy is the most important cause and can reveal the seropositivity. Among the other HIV otoneurological manifestations, hearing loss is frequent and of multiple origins. It is associated with early abnormal auditory brainstem responses. Vestibular dysfunction in HIV infection mostly concerns advanced stages of the disease even though early pathologic electrophysiologic findings are noted...

Infection with Borrelia burgdorferi is responsible for Lyme disease, an uncommon disorder in our country. It should be stressed that any of the neurologic manifestations of this disease may occur alone and may be the presenting manifestation of the illness. Several reports suggest that 1/4 of idiopathic Bell's palsies can be associated with this infection and in Europe is the most common cause of childhood facial nerve paresis. The same disease has been related to sudden deafness and vertigo cases. For its important therapeutic and prognostic implications the diagnosis of a Lyme disease must be taken into account in every case of peripheral facial nerve palsy, specially in children, in bilateral or recurrent cases and in those cases associated to other cranial neuritis or general manifestations...

Megadolichobasilar is a vascular anomaly consisting of widening and elongation of the basilar artery. It is rare and may produce otoneurological manifestations such as vertigo, sudden deafness, trigeminal neuralgia, and facial spasm or palsy. Six cases of megadolichobasilar diagnosed by magnetic resonance angiography are reported and their pathogenesis is discussed.

Symptoms such as tinnitus, hearing and taste disorders and facial palsy seldom occur in multiple sclerosis. Although ENT symptoms are few, vestibular and acoustic stapedius reflex tests combined with brainstem auditory evoked potentials (BAEPs) are available, and may give very useful evidence of the existence of MS. 52 patients with definite MS, and 13 patients with probable MS were examined (classified according to the McAlpine criteria). The vestibular and acoustic stapedius reflex tests were abnormal in 51%/61% and 61%/53% respectively of both groups...

The contribution of carotid and vertebral angiography for surgical planning, particularly for the infratemporal approach, in 24 jugulotympanic paragangliomas with otoneurological symptoms is discussed. These symptoms included peripheral facial palsy, sensorineural hypoacusis, labyrinthine and nervous syndrome of the jugular foramen. Angiography was essential for the diagnosis of these tumors and, above all, for the rigorous evaluation of intrapetrous and apical invasion of the carotid artery, and also of extra and intradural posterior fossa extensions...

In patients with various otoneurological diseases like hearing loss, neuronitis vestibularis, Ménière's disease and Bell's palsy, analyses concerning the immunoregulation and immunogenetics were done. For analysing the immunoregulation the T-helper (CD4) T-suppressor (CD8) ratio was determined. In contrast to patients with hearing loss caused by otobasal fractures and a healty control group, this ratio was elevated in 50% of the patients suffering from hearing loss. The elevation of the CD4/CD8 ratio was mainly caused by a reduction of CD8 positive cytotoxic-suppressor T-lymphocytes...

It is generally assumed, that a disturbance of microcirculation is the common pathogenetic end factor in various cochleovestibular disorders of different etiology. Therefore improvement of microcirculation is an important therapeutic goal. Several studies demonstrated, that hydroxyethylstarch (HES) has better haemorheological effects than Dextran and less side effects. For this reason we have changed the therapy with Dextran since 1987 to hydroxyethylstarch in several oto-neurological disorders (as sudden hearing loss, neuronopathia vestibularis, idiopathic facial palsy)...

This is a report of three patients who presented at the Mayo Clinic over a two-year period. All were initially diagnosed as having Bell's palsy but were later found to have a malignant neoplasm causing the paralysis. Two of the patients had breast carcinoma metastases involving the mastoid portion of the facial nerve. The third patient had an adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen. The course of the facial paralysis in the two patients with the metastitic breast disease was almost identical...

A review of the otoneurologic findings in 500 patients with facial paralysis revealed their importance for diagnosis, prognosis, and understanding the pathophysiology of Bell's palsy. Diagnosis. The presence of simultaneous bilateral palsy, facial paralysis associated with lateral rectus palsy, slowly progressive facial weakness with or without hyperkinesis, and facial paralysis that showed no recovery after six months excluded Bell's palsy from the diagnosis. Ipsilateral recurrent palsies were another indication to suspect an underlying cause, since a tumor of the facial nerve caused the paralysis in 30% of the patients with this finding...