What is the term for Bell's palsy caused by otitis media?

Otogenic Facial Paralysis: When Otitis Media Causes Facial Nerve Palsy

When otitis media causes Bell's palsy, it is specifically called otogenic facial paralysis or otitis media-associated facial nerve palsy. This condition represents a distinct entity from idiopathic Bell's palsy, as it has an identifiable cause.

Distinguishing from True Bell's Palsy

According to the clinical practice guidelines, Bell's palsy is specifically defined as:

• Acute unilateral facial nerve paresis or paralysis
• Onset in less than 72 hours
• Without an identifiable cause 1

When facial paralysis occurs secondary to otitis media, it should not be classified as Bell's palsy, since Bell's palsy is idiopathic by definition. The guidelines clearly state that Bell's palsy is diagnosed only when "no other medical etiology is identified as a cause of the facial weakness" 1.

Pathophysiology of Otogenic Facial Paralysis

The facial nerve paralysis associated with otitis media occurs through several mechanisms:

• Inflammatory process: The pathological process in chronic suppurative otitis media causes changes in the mucosa of the middle ear, manifested by edema, submucous fibrosis, and infiltration with inflammatory cells 2
• Bone erosion: Progressive spreading of inflammation can cause osteitis, which may lead to invasion and bone destruction of the facial canal 2
• Direct compression: Swelling, granulation tissue, or cholesteatoma can compress the facial nerve 2
• Bacterial toxins: These may penetrate the nerve and provoke neuritis with varying degrees of edema 2

Clinical Presentation

Patients with otogenic facial paralysis present with:

• Signs of otitis media (ear pain, discharge, hearing loss)
• Facial weakness or paralysis on the same side as the ear infection
• Inability to raise the forehead, close the eye, or control movement of the cheek and lips on the affected side 2

Treatment Approach

Treatment for otogenic facial paralysis differs from idiopathic Bell's palsy:

1. Antibiotics: Parenteral antibiotics (ampicillin-sulbactam or third-generation cephalosporins) are the mainstay of treatment 3

2. Corticosteroids: Should be administered in conjunction with antibiotics, except in patients with contraindications such as diabetes mellitus 3

3. Myringotomy: Drainage of the middle ear through myringotomy with or without ventilation tube placement is indicated when spontaneous perforation of the tympanic membrane is not present 3

4. Mastoidectomy: Reserved for cases with worsening otitis after initial treatment or when necessary to treat the underlying otitis media 3

5. Facial nerve decompression: Generally not necessary in most cases 3

Prognosis

The prognosis for otogenic facial paralysis is generally good:

• Most patients recover normal facial function regardless of the initial grade of paralysis 3
• Recovery time varies from 2 weeks to 3 months in most cases 3
• More extensive surgical interventions may be associated with longer recovery times 3

Special Considerations in Children

Facial palsy due to acute otitis media is more frequently seen in infants and young children 4, 5. Even newborns can be affected, as documented in case reports of facial nerve palsy with acute otitis media during the first 2 weeks of life 6.

Important Distinctions from Bell's Palsy Management

It's crucial to recognize that while Bell's palsy treatment focuses on steroids with optional antiviral therapy 1, otogenic facial paralysis requires:

• Targeted antibiotic therapy
• Consideration of surgical drainage procedures
• Treatment of the underlying ear infection

Pitfalls to Avoid

1. Misdiagnosis: Patients with otogenic facial paralysis are often wrongly classified and treated as having Bell's palsy 2

2. Delayed treatment: Late or inadequate treatment can lead to progression of disease and development of other otogenic complications 2

3. Unnecessary surgical intervention: Facial nerve decompression should not be performed routinely, as conservative management is usually sufficient 3

4. Failure to examine the ear: The clinical picture of peripheral facial palsy is identical regardless of etiology, making examination of the middle ear imperative in every patient with facial paralysis 2