Zaburzenie czynności nerwu twarzowego w ostrym zapaleniu ucha środkowego
Facial nerve disorders belong to the most frequent complications of acute otitis media. The nerve is damaged by spread of viral or bacterial infection from the middle ear. The treatment depends on the whole clinical picture with special regard to possible concomitant complications. The aim of this study was to analyse epidemiology, clinical characteristics and treatment options for patients with post-infectious facial nerve paralysis. Clinical and epidemiological data were collected on all patients treated for acute otitis media in the Department of Otolaryngology, Medical University in Gdańsk, between 1.01.1995 and 31.12.2009. 9 patients (5 children and 4 adults with age range between 2 to 80) with facial nerve paralysis or paresis were enrolled in the study. The level of paresis was assessed according to House-Brackmann grading scale. Bacteriology, laboratory and radiological findings were analyzed. All patients were treated with intravenous antibiotics and steroids and all underwent paracentesis followed by physiotherapy. 5 patients as classified to grade II-III and 4 patients as grade IV-V according to HB scale. In 4 patients gram-positive bacteria were isolated, in 5 cases the culture showed no growth. Paracentesis was performed in all patients, in 2 cases additionally drainage of the tympanic cavity was employed. In one patient antromastoidectomy was carried out. Intravenous antibiotics were given during the course of 7 to 14 days. One of the most important concerns was to prevent the eye from irritation and drying out. Electro- and phototherapy were commenced as soon as the acute stage of inflammation diminished and was continued in ambulatory care. Improvement in nerve function was achieved in all patients. The patients made a full recovery within 2 to 6 months since the onset of the disease. Facial nerve disorders may occur as an intratemporal bone complication of acute otitis media, which requires intravenous antibiotic and steroid therapy, paracentesis, and in some cases drainage of the tympanic cavity. The results of treatment of facial nerve palsy in acute infecions of the middle ear are usually good. Nerve decompression in most cases is unnecessary.