FACIAL PALSY IN ASOM : AN UNCOMMON PRESENTATION

Introduction: Acute Suppurative Otitis Media (ASOM) is a common childhood infection. However, complication with facial nerve palsy is a rare but significant occurrence, representing a medical urgency. This case report details the presentation, management, and outcome of a 5-year-old male with ASOM-associated facial palsy.

Case Report: A previously healthy 5-year-old male presented with acute-onset left-sided facial weakness. History revealed a preceding upper respiratory tract infection with cough, cold, and fever. Otoscopic examination confirmed left ASOM and right serous otitis media (OME). Initial conservative management with antibiotics and analgesics yielded no improvement in facial nerve function. The child subsequently underwent bilateral myringotomy with insertion of a grommet on the left side. Intraoperative diagnostic nasal endoscopy revealed Grade 4 adenoid hypertrophy. Significant improvement in facial palsy was noted by the fifth postoperative day. Three months later, the patient successfully underwent elective adenoidectomy (Tonsillectomy and Adenoidectomy - TAR) to address the underlying pathology and prevent recurrence.

Discussion: Facial palsy in ASOM is believed to result from direct inflammation and neuropraxia of the dehiscent tympanic segment of the facial nerve or via congenital bony defects. Timely surgical intervention with myringotomy and ventilation tube insertion is the cornerstone of management, providing immediate decompression and drainage. The presence of significant adenoid hypertrophy is a known risk factor for recurrent otitis media, and its removal is often indicated to ensure long-term resolution.