Pediatric Peripheral Facial Nerve Palsy – the Role of Ear Pathology

Abstract Background: Nearly half of the acquired cases of peripheral facial nerve palsy (PFNP) are of unknown etiology, a condition termed Bell's palsy (BP). PFNP in children can often be associated with acute otitis media (OM). Differences between the clinical course and prognosis in OM-associated PFNP (OM-PFNP) and BP in children are not well characterized. Methods: Retrospective review of all children hospitalized in a tertiary care children's hospital between January 2006 and December 2020 with a diagnosis of non-traumatic and non-surgery associated PFNP. Results: Out of 177 children hospitalized with facial nerve palsy, 46 were excluded (central origin: 28; underlying neurologic condition 12; traumatic etiology: 6). A total of 131 cases of PFNP were included in the study, 80 with OM-PFNP and 51 with BP. Children with OM-PFNP were younger at presentation (38.8±50.4 Vs 96.6±74.7 months, p <0.001), presented more frequently during the winter months (32.5% Vs 25.5%, p< 0.05) and had a higher CRP value [median (IQR): 1.3 (0.18-4.2) Vs 0 (0-0) mg/dL, p< 0.005]. There was no significant difference in the corticosteroid use rate (87.5% Vs 88.2%, p=0.9). Four children with OM-PFNP (and none of the BP group) had an additional underlying pathology (petrous bone osteomyelitis, cholesteatoma, and rhabdomyosarcoma). Conclusions: Children with OM-PFNP are younger at presentation and should be assessed for the presence of a significant associated middle ear/ petrous bone pathology.