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Clinical Problem Solving
June 2014

Otalgia, Facial Nerve Paralysis, and Hearing Loss

Author Affiliations
  • 1Stanford University School of Medicine, Stanford, California
JAMA Otolaryngol Head Neck Surg. 2014;140(6):575-576. doi:10.1001/jamaoto.2014.621

A woman in her 40s was referred for an 8-day history of left facial nerve paralysis, left-ear hearing loss, and vertigo. Three days after her paralysis started, she noticed left ear pain with clear discharge. She had no prior episodes of hearing loss or imbalance, and there was no significant medical history.

Findings from the patient’s physical examination were notable for a complete left facial paralysis (House-Brackmann grade 6/6) and erythematous skin in the left external auditory canal and conchal bowl with multiple lesions that had crusted over (Figure, A [unaffected ear] and B [affected ear]). Her tympanic membrane was intact, and there was no middle ear effusion. Audiometric evaluation revealed mild asymmetric left sensorineural hearing loss with a word recognition score of 92% for the left ear and 100% for the right ear. Because of this asymmetry, magnetic resonance imaging (MRI) of the internal auditory canals with gadolinium contrast was performed. An axial postgadolinium T1-weighted sequence with fat suppression revealed enhancement of the left facial nerve within the internal auditory canal and fallopian canal (Figure, C). The left cochlear and vestibular nerves were also enhancing, as well as the left basal turn of the cochlea.

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