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Facial Paralysis in Chronic Otitis Media with Cholesteatoma

Presenting Author: Nadir Yildirim

Published online by Cambridge University Press:  03 June 2016

Nadir Yildirim ,
Sinan Aksoy  and
Sermin Tok
Nadir Yildirim
Affiliation:
Dumlupinar Universitesi Medical Faculty
Sinan Aksoy
Affiliation:
DPU Medical Faculty Department of ORL-HNS
Sermin Tok
Affiliation:
Mersin University Department of Radiology
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Abstract

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Learning Objectives:

Objective: Facial paralysis is a rare and drastic complication of chronic otitis media and middle ear cholesteatoma. The predisposing factors that lead to facial nerve paralysis in choesteatomatous ears are still obscure. Herewith, we aimed to investigate the possible etio-pathogenesis of facial paralyisi in our cholesteatoma cases.

Material and Methods: We retrospectively reviewed the charts of 5 facial nerve paralysis cases that were connected to co-existing chronic otitis media with cholesteatoma and compare our findings with reported case series in literature. The duration and degree of facial paralysis, temporal bone CT findings including the size of the mastoids, dehiscence of the fallopian canal and other accompanying radiological abnormalities such as semicircular canal dehiscence, and intraoperative findings were noted.

Results: In the years of 2014–2015 we admitted 156 primary of recurring cases of middle ear cholesteatoma in our clinic, 5 (3.2%) of which also had associated facial paralysis. This percentage was comparable to those of reported series. Of those patients, 2 of whom had already been operated with canal wall-down (CWD) technique years ago for cholesteatoma that recurred. According to House-Brackmann (H-B) classification, one patient had grade 5, one patient grade 4, two patients grade 3 and one patient grade 2 paralyses. All three previously unoperated cases had relatively smaller mastoids and lateral semicircular canal (LSSC) dehiscence, detected either on CT and/or perioperatively. Fallopian canal dehiscences were in tympanic segment in 3 and in mastoid segment in 2 of the patients. All patients were operated with CWD technique as to include facial canal decompression. All but one paralyses were regressed to either HB-1 (3 cases) or HB-0 (1 case) grades postoperatively.

Discussion and Conclusion: It appears that previously existing facial canal dehiscence and small mastoids predisposes both facial canal and LSSC erosion in untreated chronic otitis media with cholesteatoma as to result in facial nerve palsy.