Facial Nerve Paresis as a Complication of Acute Otitis Media—A 6-Year Retrospective Observational Study

Background/Objectives: Facial nerve paresis (FNP) is a well-known infratemporal complication of acute otitis media (AOM). The objective of this study was to characterize pediatric patients affected by FNP secondary to AOM under different management protocols, to assess short-term outcomes, and to identify factors requiring extensive surgical intervention in our cohort. Methods: A retrospective, observational, and descriptive analysis of patients hospitalized at the department between 2020–2025 due to FNP in the course of AOM was performed. Data were collected and analyzed using Microsoft Excel and a publicly available online calculator. Results: A total of 29 patients matching the inclusion criteria were identified, with mean age of 8.0 years. Upon admission, the House–Brackmann (HB) grade was mostly III or higher, whereas most patients were discharged with a grade of II or lower, indicating favorable short-term outcomes. All patients received antibiotic treatment, with the majority receiving concomitant steroid treatment (93.1%) and surgical intervention. An HB grade of IV on admission and a duration of symptoms exceeding two weeks were nominally significant factors associated with mastoidectomy in our cohort (p = 0.01 for both variables). No nominally significant differences were found between the mastoidectomy and non-mastoidectomy groups regarding inflammatory marker levels, ear discharge on admission, or a history of AOM within the month prior to hospitalization. Conclusions: FNP secondary to AOM in children carries a favorable prognosis. However, standardized treatment guidelines in this entity are still lacking, and most centers rely on institutional experience. Multicenter studies are warranted to standardize management protocols.