From the Guidelines
Sensorineural Hearing Loss with Concurrent Facial Paralysis
Sensorineural hearing loss accompanied by facial paralysis is a clinical presentation that warrants prompt evaluation and treatment. The most common cause of this presentation is Bell's palsy, which is characterized by acute unilateral facial nerve paresis or paralysis with onset in less than 72 hours and without an identifiable cause 1.
Causes and Pathophysiology
The exact mechanism of Bell's palsy is currently unknown, but it is thought to result from facial nerve inflammation and edema 1. As the facial nerve travels in a narrow canal within the temporal bone, swelling may lead to nerve compression and result in temporary or permanent nerve damage. This can also affect the stapedius muscle, leading to hyperacusis, and the taste fibers from the anterior tongue, resulting in taste disturbance or loss 1.
Management
In cases of acute facial paralysis, such as Bell's palsy, hearing loss may be managed with:
- Corticosteroids, specifically prednisone 60-80 mg daily for 5-7 days, to reduce inflammation and edema.
- Antiviral medications like valacyclovir 1000 mg three times daily for 7-10 days may be considered if a viral etiology is suspected. Further evaluation by an otolaryngologist or neurologist is recommended to determine the underlying cause and guide appropriate management 1.
Key Points
- Bell's palsy is a diagnosis of exclusion, requiring careful elimination of other causes of facial paresis or paralysis 1.
- Patients with Bell's palsy may experience dryness of the eye or mouth, taste disturbance or loss, hyperacusis, and sagging of the eyelid or corner of the mouth 1.
- Imaging studies, such as CT or MRI, may be used to identify underlying causes of facial paralysis, such as tumors or vascular lesions 1.
- Surgical decompression of the facial nerve may be considered in some cases, but the evidence is limited and the benefit is still controversial 1.
Important Considerations
- Prompt evaluation and treatment are crucial to prevent long-term complications and improve outcomes.
- Further evaluation by a specialist is recommended to determine the underlying cause and guide appropriate management.
- Supportive care, such as symptomatic treatment for ocular complications, may be necessary to manage symptoms and prevent further complications 1.
From the Research
Causes of Sensorineural Hearing Loss with Concurrent Facial Paralysis
- Sensorineural hearing loss with concurrent facial paralysis (facial nerve palsy) can be caused by various factors, including Ramsay Hunt syndrome, which is a late manifestation of varicella-zoster virus infection 2, 3.
- Ramsay Hunt syndrome occurs when the varicella-zoster virus reactivates, infects, and produces an inflammatory reaction in the seventh cranial nerve geniculate ganglion, leading to facial nerve palsy and hearing impairment 2.
- The clinical manifestations of Ramsay Hunt syndrome can vary, but common symptoms include auricular vesicles, facial paralysis, and vestibulo-cochlear dysfunction 3.
- Hearing loss in Ramsay Hunt syndrome can be subjective or objective, and may appear before, during, or after the onset of facial paralysis 3.
Diagnosis and Treatment
- Diagnosis of sensorineural hearing loss with concurrent facial paralysis typically involves a combination of clinical evaluation, audiometry, and imaging studies such as computed tomography or magnetic resonance imaging 4.
- Treatment options for sensorineural hearing loss with concurrent facial paralysis depend on the underlying cause, but may include antiviral medications, steroids, and anti-inflammatory agents for Ramsay Hunt syndrome 2.
- In some cases, treatment may also involve auditory rehabilitation, education, and elimination or reduction of ototoxic medications 4.
Other Possible Causes
- Other possible causes of sensorineural hearing loss with concurrent facial paralysis include Bell's palsy, which is an idiopathic acute facial paralysis 5, 6.
- However, a study found no significant relationship between COVID-19 and cases of sudden sensorineural hearing loss (SSNHL) and Bell's palsy 6.