Facial nerve paralysis due to chronic otitis media.

OBJECTIVE: To present the characteristics of facial paralysis caused by chronic otitis media. The role of cholesteatoma, bony dehiscence, the duration of the disease, and the results of surgical therapy in facial paralysis were reviewed.

STUDY DESIGN: Retrospective case review.

SETTING: Tertiary care referral center.

PATIENTS: A total of 24 patients (6 women, 18 men; age range, 17-74 yr) with facial paralysis were included in the study.

INTERVENTION: Canal wall down mastoidectomy was performed in 14 patients (58.3%), modified radical mastoidectomy was performed in seven patients (25%), and intact canal wall mastoidectomy was performed in three patients (16.7%). All patients had decompression of the fallopian canal from the geniculate ganglion to the stylomastoid foramen without opening the epineural sheath.

RESULTS: Eighteen patients (75%) had gradual onset of facial paralysis. The most common associated symptom with facial paralysis was vertigo in six patients. Twelve patients (50%) had no associated symptoms. Facial paralysis was the sole complication in 21 patients (87.9%). Three patients had multiple complications. Labyrinthitis was the most common associated complication. Facial paralysis was associated with congenital cholesteatoma in one patient. Fourteen patients (58.3%) demonstrated dramatic recovery within 3 months after surgery. Intraoperatively, cholesteatomas were found in 17 of the patients (70.8%). The fallopian canal was intact in four patients (none of them had a cholesteatoma), and 20 patients had bone destruction or dehiscence (three patients had no cholesteatoma). The tympanic segment was the most common site of involvement in 14 patients (58.3%).

CONCLUSION: A middle ear cholesteatoma was present in the majority of patients with facial paralysis caused by chronic otitis media. Gradual onset of facial paralysis was the most frequent pattern. Facial paralysis presented poor prognosis regardless of the presence of a cholesteatoma. There was no statistical difference among the results of surgical techniques.