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Review
. 2023 Nov 8;13(6):889-897.
doi: 10.3390/audiolres13060077.

Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm

Piergabriele Fichera  1 , Luca Bruschini  1 , Stefano Berrettini  1 , Silvia Capobianco  1 , Giacomo Fiacchini  1
Affiliations
Review

Acute Otitis Media and Facial Paralysis in Children: A Systemic Review and Proposal of an Operative Algorithm

Piergabriele Fichera et al. Audiol Res. .

Abstract

Acute otitis media (AOM) is one of the most common ENT diseases in children. In the antibiotic/post-antibiotic era, facial paralysis is a very rare complication of AOM (0.004-0.005%). Despite the rarity of this complication, it should be known by all physicians for proper therapeutic management to avoid serious sequelae. The aim of this review is to provide a management guide based on the current literature.

Materials and methods: Fifteen studies published between 2000 and 2022 were selected, including 120 patients (62 M/58 F) with an average age of 4.96 years old (range = 4 months-16 years; SD: 4.2). The paralysis frequently has a sudden onset and is of a severe grade (medium House-Brackmann (HB) score at onset: 4.68; SD: 0.5); however, it tends to have an almost complete recovery in most patients (88.49% HB 1 at follow-up).

Results: Its first-line treatment must be based on the use of antibiotics (beta-lactam antibiotics as penicillins or cephalosporins). Corticosteroids should be used concomitantly for their anti-inflammatory and neuroprotective actions; however, there is no unanimity between authors about their application. Myringotomy, with or without ventilation tube insertion, is indicated in cases where the tympanic membrane is intact. Other kinds of surgery should be performed only in patients who have a worsening of their AOM symptoms or a worsening in HB score even with clinical treatment.

Conclusions: The obtained data show that a conservative treatment can be sufficient for complete recovery in most patients, and it is preferred as the first-line therapy. Mastoidectomy should be performed only in patients with acute mastoiditis and without symptom improvement after a conservative approach. There are insufficient data in the current literature to provide clear selection criteria for patients who need to undergo mastoidectomy with facial nerve decompression. The choice of this treatment is based on an individual center expertise. Further studies are needed to clarify the role of corticosteroids and the role of facial nerve decompression in this clinical scenario.

Keywords: AOM; acute otitis media; facial palsy; facial paralysis; middle ear inflammation; pediatric facial palsy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA. Full text articles excluded: Facial Paralysis in Children—Reddy et al., 2015 doi: 10.1055/s-0035-1549042; Subtotal facial nerve decompression for recurrent facial palsy in Melkersson Rosenthal syndrome—Chuanfu Dai, Shui Feng et al., 2014 doi: 10.3109/00016489.2013.863431; Paediatric facial paralysis: An overview and insights into management—Malik et al., 2021 doi: 10.1111/jpc.15498; Pediatric neurotology—Miyamoto et al., 2003 doi: 10.1016/s1071-9091(03)00070-6; Investigation and treatment of facial paralysis—Arch Dis Child 2001 doi: 10.1136/adc.84.4.286; Acute Otitis Media and Facial Paralysis in an Infant with Aural Atresia: Management of a Rare Case—Kokoglu et al., 2021 doi: 10.5152/JIAO.2021.8569.
Figure 2
Figure 2
Patients’ facial palsy grades.
Figure 3
Figure 3
Suggested management algorithm for AOP + FP.
See this image and copyright information in PMC

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