An unusual case of recurrent facial nerve palsies

Introduction A 22-year-old patient reports four episodes of temporary left-sided facial palsy when flying. Initially he noticed a "closing" of the ear with piercing otalgia. After equalization, symptoms improve almost immediately.

Methods We performed a selective literature research: Few cases of recurrent facial palsy during changes in ambient pressure are mostly described for divers and, more rarely, for air travellers. Pathophysiologically, a microcirculation disorder in the absence of bony coverage of the facial nerve in the tympanic portion is discussed: In combination with insufficient adaptation to the changed ambient pressure, a temporary ischemic neurapraxia develops according to middle ear barotrauma, which is reversible after pressure equalization.

Results A so-called 'facial baroparesis' is described by different authors with a comparable history, but usually as a one-off event. Bony dehiscence of the facial canal in the tympanic segment is detectable in the patient's CBCT. However, this is not a rare finding in asymptomatic patients. In the present case an ipsilateral, chronic sinusitis in combination with a massive deviated nasal septum could cause a latent inadequate middle ear ventilation.

Conclusion Triggering factors of a disturbed middle ear ventilation must be clarified and treated. The use of topical a1-adrenoceptor agonists before and during a flight is recommended. Other treatment options include training of the tubal function, balloon dilatation and tympanostomy.

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Publication History

Article published online:
07 August 2020