Facial nerve palsy, acute otitis media and Epstein-Barr virus infection
DOI:
https://doi.org/10.34631/sporl.3075Keywords:
Facial nerve palsy, Acute otitis media, Epstein-Barr virus, Infectious mononucleosisAbstract
Introduction: Facial nerve palsy is a rare complication of acute otitis media. Despite most cases are assumed to have a bacterial origin, in a significant proportion of them there are no clinical or laboratorial signs indicative of bacterial infection. A viral etiology was proposed in some of these cases.
Case summary: In this work we present a case of facial nerve palsy secondary to acute otitis media caused by Epstein-Barr virus infection in a 3-year-old boy and review the previously published cases on this subject, focusing on clinical presentation, diagnosis, and treatment of this condition.
Discussion: Acute otitis media with facial nerve palsy can be a manifestation of Epstein-Barr virus primary infection. This etiology must be considered in all cases of facial nerve palsy secondary to acute otitis media, namely in those cases that lack signs of bacterial infection.
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Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis. 1989 Jul;160(1):83-94. doi: 10.1093/infdis/160.1.83.
Casselbrant ML, Mandel EM. Epidemiology. In: Rosenfeld RM, Bluestone CD. Eds. Evidence-Based Otitis Media, 2nd Ed. Oxford: Elsevier, 2003. p. 147-162
Gates GA. Acute otitis media and otitis media with effusion. Otolaryngology, Head and Neck Surgery 3rd ed St Louis: Mosby. 1998.
Lesperance MM. Cummings Pediatric Otolaryngology. Elsevier Health Sciences; 2021.
Teixeira DN, de Figueiredo MV, Fernandes RG, Muranaka, Lobo JAA, de Sales Chagas JF. et al. Peripheral facial paralysis as a consequence of acute otitis media: physiopathology, associated factors and treatment. Otorhinolaryngol Head Neck Surg, 2020; doi: 10.15761/OHNS.1000225
Castellazzi ML, Torretta S, Pietro GMD, Ciabatta A, Capaccio P, Caschera L. et al. Acute otitis media-related facial nerve palsy in a child: a case report and a literary review. Ital J Pediatr. 2023 Jan 14;49(1):8. doi: 10.1186/s13052-022-01405-4.
Jacobsson M, Nylen O, Tjellström A. Acute otitis media and facial palsy in children. Acta Paediatr Scand. 1990 Jan;79(1):118-20. doi: 10.1111/j.1651-2227.1990.tb11344.x.
Vogelnik K, Matos A. Facial nerve palsy secondary to Epstein-Barr virus infection of the middle ear in pediatric population may be more common than we think. Wien Klin Wochenschr. 2017 Nov;129(21-22):844-847. doi: 10.1007/s00508-017-1259-y
Hyden D, Akerlind B, Peebo M. Inner ear and facial nerve complications of acute otitis media with focus on bacteriology and virology. Acta Otolaryngol. 2006 May;126(5):460-6. doi: 10.1080/00016480500401043.
Portegies P, Corssmit N. Epstein-Barr virus and the nervous system. Curr Opin Neurol. 2000 Jun;13(3):301-4. doi: 10.1097/00019052-200006000-00012.
House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. 1985 Apr;93(2):146-7. doi: 10.1177/019459988509300202.
Wang CS, Sakai M, Khurram A, Lee K. Facial nerve palsy in children: a case series and literature review. Otolaryngology Case Reports. 2021;20:100297. doi.org/10.1016/j.xocr.2021.100297
Hanci F, Türay S, Bayraktar Z, Kabakuş N. Childhood facial palsy: etiologic factors and clinical findings, an observational retrospective study. J Child Neurol. 2019 Dec;34(14):907-912. doi: 10.1177/0883073819865682
Evans AK, Licameli G, Brietzke S, Whittemore K, Kenna M. Pediatric facial nerve paralysis: patients, management and outcomes. Int J Pediatr Otorhinolaryngol. 2005 Nov;69(11):1521-8. doi: 10.1016/j.ijporl.2005.04.025.
Psillas G, Antoniades E, Ieridou F, Constantinidis J. Facial nerve palsy in children: a retrospective study of 124 cases. J Paediatr Child Health. 2019 Mar;55(3):299-304. doi: 10.1111/jpc.14190.
Heikkinen T. Role of viruses in the pathogenesis of acute otitis media. Pediatr Infect Dis J. 2000 May;19(5 Suppl):S17-22; discussion S22-3. doi: 10.1097/00006454-200005001-00004.
Nowalk A, Green M. Epstein-Barr Virus. Microbiol Spectr. 2016 Jun;4(3). doi: 10.1128/microbiolspec.DMIH2-0011-2015.
Nowalk A, Green M. Epstein-Barr Virus. Microbiol Spectr. 2016 Jun;4(3). doi: 10.1128/microbiolspec.DMIH2-0011-2015.
Cohen JI. Epstein-Barr virus infection. N Engl J Med. 2000 Aug 17;343(7):481-92. doi: 10.1056/NEJM200008173430707.
Häusler M, Ramaekers VT, Doenges M, Schweizer K, Ritter K, Schaade L. Neurological complications of acute and persistent Epstein-Barr virus infection in paediatric patients. J Med Virol. 2002 Oct;68(2):253-63. doi: 10.1002/jmv.10201.
Michel RG, Pope TH Jr, Patterson CN. Infectious mononucleosis, mastoiditis, and facial paralysis. Arch Otolaryngol. 1975 Aug;101(8):486-9. doi: 10.1001/archotol.1975.00780370028010.
Naughton P, Healy M, Enright F, Lucey B. Infectious Mononucleosis: diagnosis and clinical interpretation. Br J Biomed Sci. 2021 Jul;78(3):107-116. doi: 10.1080/09674845.2021.1903683.
Hoagland RJ. Infectious mononucleosis. Prim Care. 1975 Jun;2(2):295-307.
Topp SK, Rosenfeldt V, Vestergaard H, Christiansen CB, Von Linstow ML. Clinical characteristics and laboratory findings in Danish children hospitalized with primary Epstein-Barr virus infection. Infect Dis (Lond). 2015;47(12):908-14. doi: 10.3109/23744235.2015.1082036.
Tan JW, Hu J-R. Fever with atypical lymphocytosis: pearls and pitfalls in Epstein-Barr virus serology. BMJ Case Rep. 2023 May 3;16(5):e250081. doi: 10.1136/bcr-2022-250081.
Womack J, Jimenez M. Common questions about infectious mononucleosis. Am Fam Physician. 2015 Mar 15;91(6):372-6.
Papan C, Kremp L, Weiß C, Petzold A, Schroten H, Tenenbaum T. Infectious causes of peripheral facial nerve palsy in children-a retrospective cohort study with long-term follow-up. Eur J Clin Microbiol Infect Dis. 2019 Nov;38(11):2177-2184. doi: 10.1007/s10096-019-03660-6.
Eeten EV, Faber H, Kunst D. Surgical treatment for Epstein-Barr virus otomastoiditis complicated by facial nerve paralysis: a case report of two young brothers and review of literature. J Int Adv Otol. 2017 Apr;13(1):143-146. doi: 10.5152/iao.2017.2788.
Yamaguchi M, Suzuki M, Morita M, Hasegawa S, Ito Y. Facial nerve palsy with acute otitis media associated with EB virus infection. Pediatr Int. 2021 May;63(5):599-600. doi: 10.1111/ped.14451
Turgeon RD, Wilby KJ, Ensom MH. Antiviral treatment of Bell's palsy based on baseline severity: a systematic review and meta-analysis. Am J Med. 2015 Jun;128(6):617-28. doi: 10.1016/j.amjmed.2014.11.033.
Tambini DT, Roberto. Acyclovir for treatment of infectious mononucleosis: a meta-analysis. Scand J Infect Dis. 1999;31(6):543-7. doi: 10.1080/00365549950164409.
Gaio E, Marioni G, de Filippis C, Tregnaghi A, Caltran S, Staffieri A. Facial nerve paralysis secondary to acute otitis media in infants and children. J Paediatr Child Health. 2004 Aug;40(8):483-6. doi: 10.1111/j.1440-1754.2004.00436.x.
Joseph EM, Sperling NM. Facial nerve paralysis in acute otitis media: cause and management revisited. Otolaryngol Head Neck Surg. 1998 May;118(5):694-6. doi: 10.1177/019459989811800525.
Chang C, Cass SP. Management of facial nerve injury due to temporal bone trauma. Am J Otol. 1999 Jan;20(1):96-114.
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Copyright (c) 2025 Diogo Cabral, André Alves Carção, Pedro Marques Gomes, Gustavo Lopes, Delfim Duarte, José Ferreira Penêda
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