Tuberculous Otitis Media : an Usual Cause of Facial Nerve Paralysis - Anna Victoria D.G. Ramos, Howard Enriquez, Francisco Victoria 4 0 16; 5 The PLM College of Medicine and the Ospital ng Maynila Journal of Medicine. October 2013. pp. 46
ABSTRACT : Objectives : The study aims (1) report a case of a pediatric patient with facial nerve paralysis arising from tuberculous otitis media (2) present the differential diagnosis and clinical presentation of the disease (3) identify diagnostic and treatment modalities employed in these patients Methods : Study Design : Case Report Setting : Tertiary Hospital Patient : One Patient Results : A 9 year old male patient was referred to our institution due to right facial asymmetry with a history of chronic ear discharge which was refractory to medical treatment. On otoscopy, the right tympanic membrane was not visualized due to posterior wall sagging and clear watery ear discharge. A 3x4cm right submandibular mass was noted which was non - erythematous, non - tender, matted and movable. Facial muscle animation was graded VI on House-Brackmann Grading system. Towne's view revealed scierotic right mastoid bone. Patient was admitted with an impression of Chronic Suppurative Otitis Media with probable cholesteatoma formation and was scheduled for Radical Mastoidectomy with Facial Nerve Decompression. However, computerized tomographic (CT) scan of the temporal bone showed soft tissue density occupying the retroauricular area and middle ear with erosive changes on the right temporal bone affecting the facial nerve groove. Surgery was deffered and further work-up was done. Incision biopsy of the submandibular mass revealed chronic Granulomatous Inflammation with Caseation Necrosis & Langhans Type Giant Cells. With persistent productive cough, patient was reffered to Pediatric Pulmonologist. Sputum test was negative for AFB stained however purified protien derivative test was positive. The patient was then started with antituberculous therapy. After one week of medication, the patient showed improvement of facial asymmetry with HB III and significant decrease of posterior wall sagging and otorhhea. Continued improvement of facial asymmetry was noted and the patient was discharged after two weeks. In 3 months follow - up, facial asymmetry resolved with consequent resolution of otitis media.
Keywords: 2 -- 0; 6; Facial Nerve Paralysis;Hearing Loss -- Tuberculous Otitis Media; 20; 2