Abstract
BackgroundFacial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment.Case presentationA 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention.ConclusionsPrompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients.
Highlights
ConclusionsPrompt pressure equalization tube (PET) insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis
Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity
Prompt pressure equalization tube (PET) insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis
Summary
In a case of highly recurrent, chronic facial baroparesis during airline travel and high-altitude automobile driving, prompt treatment with PET insertion offered immediate and complete resolution of symptoms for at least 6 months despite frequent recurrent exposure to rapid altitude change. The finding of facial canal dehiscence on high-resolution CT scan may be an underlying anatomic variant associated with risk for this rare condition. Unless contraindicated on a case-specific basis, PET insertion represents a preferred treatment for patients with recurrent episodes of facial baroparesis
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