Analysis of fifty cases of facial palsy due to otitis media

Summary Fifty cases of facial palsy (FP) due to otitis media treated in our hospital during the 10-year period from 1972 to 1981 were analyzed. The averaged percentage of this incidence was 3.1% of all the FP occurring. FP due to otitis media acuta (OMA) was frequently seen in infants. FP due to otitis media chronica (OMC) tended to occur in combination with cholesteatoma or acute exacerbations of infection. Paralyses were generally mild and bacteria from the otorrhea were similar to those of OMC without FP. When present, sites of dehiscence of the facial canal were most frequently seen in its horizontal portion. Electromyographically, the posterior (mastoid) side of the horizontal portion of the facial nerve bundle seemed to be related to the branch to the orbicularis oculi muscle, while the anterior (stapes) side was directed to the orbicularis oris muscle.     

Facial paralysis in chronic suppurative otitis media

Sixty-four patients with a facial paralysis due to chronic suppurative otitis media were treated by surgical decompression during the 10-year period 1973 to 1982. Paralysis was clinically complete in 66% and incomplete in 34% of the patients. Cholesteatoma was found in 80%. Otogenic facial paralysis was more common as an isolated lesion not associated with other complications. When present, bone destruction of the facial canal was most frequently seen in its tympanic portion. The occurrence of facial paralysis did not depend on the extent of destruction of the facial canal. Facial nerve function recovered completely in 70%, partially in 24% and failure occurred in 6% of the patients.     

Observation of motorneuron after recovery from experimental facial nerve paralysis]

The localization of the motor neurons innervating facial muscles and the masseter muscle was examined by the retrograde horseradish peroxidase (HRP) technique. Ten microliters of 50% HRP was injected into the orbicularis oculi muscle, the orbicularis oris muscle, the zygomaticus muscle and the masseter muscle of rabbits. At 48 hours after the HRP injection, perfusion fixation was done through the left ventricule of the heart under general anesthesia. The brain stem was removed and reacted with diaminobenzidine. The nucleus of the orbicularis oculi muscle was distributed in the medial-dorsal portion of the facial nerve nucleus. On the other hand, the nucleus of the orbicularis oris muscle and the nucleus of the zygomaticus muscle were located in the lateral-ventral, and medial-ventral portions, respectively. The nucleus of the masseter muscle (trigeminal motor nucleus) was located about 1.1mm proximal to the facial nucleus. Experimental facial nerve palsy was produced by the following procedures. The intratemporal facial nerve was exposed under local anesthesia and crushed for 20 sec. using a hemostatic forceps. Recovery from the facial nerve palsy was evaluated by evoked electromyography 3 months later. After another 3 months, HRP was injected into the zygomaticus muscle. In animals that had recovered from the facial palsy, motor neurons labeled with HRP were found not only in the medial-ventral portion but also partially in the medial-dorsal portion, which was the position of the labeled nucleus of the orbicularis oculi muscle in control animals. However, there was no significant difference in the size or number labeled motor neurons between the control and recovered animals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Correlation between otitis media and craniofacial morphology in adults

We conducted a comparison study to determine if the development of otitis media in adults is correlated with craniofacial morphology. Our study population was made up of 66 adults, aged 18 to 40 years; 32 of these patients had otitis media and 34 did not. All subjects underwent a complete otolaryngologic examination, video-otoscopy, fiberoptic nasal endoscopy, and lateral cephalometry. Statistical analysis of the cephalometric measurements in the otitis media group and the control group revealed significant differences in the angle between the anterior skull base and medial skull base, upper facial height, and anterior facial height. Also, some significant differences were seen between the measurements in the otitis media group and the normal dimensions of the harmonic face as reported in the literature; these differences were seen in the length of the anterior skull base, the angle of cranial deflection, the depth of the maxilla, the angle of the mandibular plane, the angle of facial depth, the angle of the facial cone, and lower facial height. Not all of these significant differences, however were predictive of the evolution of otitis media. Based on our analysis, we conclude that four cephalometric measurements are predictive of the evolution of otitis media: (1) the length of the anterior skull base, (2) the angle between the anterior skull base and medial skull base, (3) maxillary depth, and (4) upper facial height. No correlations were found between otitis media and nasal blockage or between otitis media and facial type.     

Marrow-tympanum connections in fetuses and infants

The connections between hematopoietic bone marrow and the tympanum caused by bony dehiscences in immature middle ear were examined in 58 temporal bones of fetuses and infants. There were no anomalies in any of the cases, and they were divided into two groups: a group with inflammation of middle ear and a group without inflammation. The tympanic cavity was compartmentalized into thirteen portions to investigate the appearance of the connection, and the connections were classified into the mesenchymal type and the direct type dependent on residual mesenchyme in each portion. Marrow-tympanum connections were observed from 20 weeks of gestation until 14 months of age. In most cases the connections were the mesenchymal type. A large amount of mesenchyme remained in the inflammatory group. Some direct-type connections were observed in the non-inflammatory group from 1 month after birth onward and the mesenchyme was completely absorbed in these connections. Both types of the connections were frequently found in the antrum, facial recess and tympanic sinus. These results indicate that a marrow-tympanum connection is usually present in the temporal bone not only anomaly cases but also normal fetuses and infants. In addition, in normal cases without otitis media the connections first appear as mesenchymal type, and progress to direct type due to the absorption of mesenchyme. Presumably marrow-tympanum connections have structural disadvantage to induce osteomyelitis in cases with otitis media. And evoked osteomyelitis may cause complications such as acute mastoiditis and facial paralysis. The results of this study suggest that children under 2 years of age are at higher risk of complications of otitis media owing to marrow-tympanum connections than older children. Further study of the role of mesenchyme in otitis media is needed.     

Magnetic stimulation in patients with facial hemispasm

A total of 28 patients with a hemifacial spasm were examined using transcranial magnetic stimulation. The potentials were evoked cortically and cisternally; latencies and amplitudes of each potential were measured in the levator labii muscle and in the orbicularis oculi muscle. After cortical stimulation, differences in latencies were found between the healthy and the diseased side of the levator labii muscle. Prolonged latencies were measured more frequently on the diseased side (cortical stimulation). The method of magnetic stimulation is an important addition to electrophysiological diagnostic procedures in facial hyperkinesias. Cortical stimulation combined with measurements of the blink reflex and neuromyography may allow separate parts of the route of the whole facial nerve and supranuclear structures to be examined.     

全植入人工面神经恢复周围性面神经麻痹兔眼轮匝肌闭眼功能的实验研究

目的探讨全植入人工面神经恢复周围性面神经麻痹兔眼轮匝肌闭眼功能的效果。方法2018年1月至2019年5月,将人工面神经植入单侧周围性面神经麻痹兔体内,于术后第7、28天,监测患侧眼轮匝肌刺激闭合阈及患侧与健侧眼轮匝肌运动的同步性,并通过SPSS13.0软件进行t检验。结果人工面神经植入术后第7、28天,实验兔患侧眼轮匝肌的闭合阈差异无统计学意义(P值均>0.05)。在观察期间,刺激健侧眼睑20次诱发健侧闭眼,未发现健侧未动而患侧运动的情况;植入第7天和第28天,患侧与健侧同步运动的同步率在19/20~20/20,差异均无统计学意义(P值均>0.05)。结论人工面神经系统具备工作状态稳定、刺激运动效果同步性高的特点,能够较好地恢复周围性面神经麻痹动物的眼轮匝肌的闭眼功能。     

面神经周围微血管丛分布的临床研究

目的为尽可能避免医源性面神经麻痹，评估面神经水平段周围微血管丛是否可以作为耳显微或耳神经外科术中面神经的定位标志。方法从2002年7月至2005年7月，共311例因慢性中耳炎、周围性面神经麻痹以及外耳道闭锁合并中耳畸形者，分别行开放式鼓室成形术（291例）、面神经减压术（10例）和先天性耳道闭锁和中耳畸形手术（10例）。观察和评估水平段面神经周围的微血管丛作为术中定位面神经的手术标志的有效性。结果在全部病例中，有95．8％的病例（298例）手术中可满意地观察到水平段面神经周围微血管丛，位于面神经鼓室段表面，仅4．2％的病例（13例）难以在水平段面神经周围发现该微血管丛。用面神经微血管判断水平段面神经管阳性率的95％可信区间为93．6％～98．0％。结论围绕在水平段面神经周围或表面的微血管丛，可作为术中及早且直接定位面神经的手术标志，用它来迅速确定面神经水平段是可靠的。     

Clinical and electrophysiological findings of facial palsy in a case of hereditary gelsolin amyloidosis

Hereditary gelsolin amyloidosis (HGA) is an autosomal dominant systemic amyloidosis, characterized by cranial and sensory peripheral neuropathy, corneal lattice dystrophy, and cutis laxa. We report a case of HGA presenting with bilateral facial palsy. A 70-year-old Japanese man presented with slowly progressive bilateral facial palsy and facial twitching, which had started in his 40s. His mother also had the same symptoms due to an unknown cause but rest of the family did not. He showed incomplete facial palsy with no frontal muscle movement and partial movement of the orbicularis oris and orbicularis oculi muscles. The patient showed no synkinesis. Electroneurography revealed symmetric low compound motor action potential amplitude of the orbicularis oris muscle, and a nerve excitability test showed a symmetric increase in the response threshold. Despite the partial voluntary movement of the orbicularis oculi muscle, bilateral blink reflexes were absent. He also showed facial spasms after contraction of the orbicularis oris muscle. Genetic testing revealed a heterozygous c.640G>A mutation (p. Asp214Asn); therefore, the patient was diagnosed with HGA. HGA related facial palsy showed moderate bilateral, upper blanch-dominant axonal degeneration of the facial nerve without reinnervation, and trigeminal nerve neuropathy.     

Wegener’s granulomatosis presenting with bilateral facial nerve palsy

Primary manifestation of Wegener’s granulomatosis in the mucosa of the middle ear is rather rare, and has been reported as presenting with serous otitis media, chronic otitis media, sensorineural hearing loss, and, in rare instances, unilateral facial palsy. Bilateral facial palsy has never been reported. This last fact constitutes the interest in our report of a 23-year-old female patient who presented with symptoms of recurrent bilateral otitis media, eventually developing sensorineural hearing loss and bilateral facial palsy. Soon thereafter neurological symptoms appeared and lung extension was noted. Histological examination of repeated biopsies taken from the nasal and middle ear mucosa was not conclusive for the suspected disease, and c-ANCA titers were also initially repeatedly negative. Eventually, positive lung biopsy and elevated c-ANCA titers when the patient had developed pulmonary granulomas confirmed the diagnosis of Wegener’s granulomatosis. Mastoid surgery with facial nerve decompression of the most severely afflicted side did not result in the recovery of facial nerve function. Medical therapy with corticosteroids and cyclophosphamide improved the clinical picture but were ineffective in improving the bilateral sensorineural hearing loss and the facial paralysis on the operated side. We would contribute to the literature a unique case of bilateral facial nerve palsy due to Wegener’s granulomatosis. Received: 13 December 2000 / Accepted: 5 February 2001     

Facial palsy in acute otitis media

During the 17-year period from 1977 to 1994 a total of 23 patients in Copenhagen County were admitted to hospital with facial palsy, developed during acute otitis media. This corresponds to an annual incidence of 2.3 per million inhabitants. In the pre-antibiotic era it was estimated that 0.5% of patients with acute otitis media developed facial palsy. Our figures indicate a decrease of this complication by a factor of 100, to 0.005%. Although fourteen of the patients were children, the risk of an acute otitis media being complicated by facial palsy seems to be highest in adults (who have a low incidence of acute otitis media). All the children were ≤3 years of age and 2/3 of the adults ≥50 years of age. Complete remission was seen in all patients, except one. The time interval to complete remission was correlated significantly with the degree of the facial palsy on admission, as it was longest in the most severe facial palsies.     

Diagnosis of the pathological exposure of the mastoid portion of the facial nerve by CT scanning

CONCLUSIONS: High resolution CT imaging can provide useful information about the pathological exposure of the mastoid portion of the facial nerve before mastoid surgery and can assess the injury site of the facial nerve after operation. OBJECTIVES: To evaluate the diagnostic value of high resolution CT scanning of pathological exposure of the mastoid portion of facial nerve and provide valuable information for otologic surgery, and to analyse the cause of facial nerve paralysis after operation. MATERIALS AND METHODS: Routine CT scanning was used to examine patients with chronic suppurative otitis media and external auditory canal cholesteatoma preoperatively by axial-transverse and coronal views. If there was any pathological exposure of the mastoid portion of the facial nerve on CT imaging, then this was compared with intraoperative findings. In addition, one patient who had suffered postoperative facial nerve paralysis was also examined by CT scanning to determine whether any pre-existing pathological exposure of facial nerve could be found. RESULTS: Through routine CT scanning six patients with chronic suppurative otitis media and three patients with external auditory canal cholesteatoma were found to have pathological exposure of the mastoid portion of the facial nerve. Coronal views could more clearly show the size and the position of the exposure; the corresponding surgical findings (pathological exposure) for the facial nerve could be confirmed in all nine patients. CT imaging could also show that the patient who had suffered postoperative facial nerve paralysis did indeed have pre-existing pathological exposure of the mastoid portion of the facial nerve.     

Diverse etiologies of facial paralysis in children

Facial paralysis (FP) in children is most often idiopathic, however, many diverse and identifiable etiologies exist. Twenty-five cases of children admitted consecutively to the Children's National Medical Center over 8.5 years for the evaluation of FP were reviewed retrospectively. In 21 (84%) of the patients the FP was discovered to be secondary to a specific etiology or associated with a recognizable syndrome. In 7 cases, the FP was an initial manifestation of a serious underlying disorder. Causes of the FP in this series include: otitis media, mastoiditis, temporal lobe abscess, osteopetrosis, both blunt and penetrating trauma, iatrogenic surgical injury, facial burns, cerebellar astrocytoma, leukemia rhabdomyosarcoma, intracerebral arteriovenous malformation, Goldenhar syndrome, and Melkersson-Rosenthal syndrome. Four (16%) patients were diagnosed as having Bell's palsy. Methods of management, including the use of electrodiagnostic testing are described.     

中耳炎性病变患者的人工耳蜗植入

目的探讨伴中耳炎性病变的患者进行人工耳蜗植入的适应证、手术方法和术后并发症的发生情况。方法对1995年5月至2006年2月完成的866例人工耳蜗植入术的临床资料进行回顾性分析。术前或术中发现伴中耳乳突炎性病变患者共41例，其中男17例，女24例，年龄1岁3个月-38岁，平均10岁2个月；左耳人工耳蜗植入18例，右耳植入23例，均为单侧植入。其中慢性分泌性中耳炎13例，隐蔽性中耳炎18例，中耳炎后遗症鼓膜穿孔1例，双侧胆脂瘤中耳炎2例，中耳乳突肉芽肿7例。中耳炎性病变伴内耳、中耳畸形7例。对于双侧胆脂瘤中耳炎乳突根治术后患者，设计采用了带蒂翻转帽状腱膜法保护植入电极和面神经。结果41例患者经 Ⅰ期或分期手术，术后随访时间5个月至6年11个月，平均未发现耳部炎性并发症，装置工作良好。结论慢性非化脓性中耳炎、中耳乳突肉芽肿、中耳炎后遗症伴鼓膜穿孔者可采用Ⅰ期或分期方法行人工耳蜗植入。胆脂瘤中耳炎在彻底去除病变基础上可分期行人工耳蜗植入术。对于乳突根治术后没有足够组织覆盖保护植入电极的病例，可采用带蒂翻转帽状腱膜方法。存在活动性中耳乳突炎症者为手术禁忌证。中耳炎性病变患者人工耳蜗术后应长期随访。     

耳源性面神经麻痹的手术治疗

目的 总结由于中耳炎、Hunt综合征、肿瘤及理化损伤4种常见耳源性疾病导致的面神经麻痹手术治疗的经验,增加对手术治疗耳源性面神经麻痹的认识.方法 回顾性分析1991年10月至2007年3月间由于上述4种耳部疾病导致面神经麻痹的24例患者的临床资料.面神经功能评估采用House-Brackman分级.结果 24例患者中男10例,女14例;年龄14～82岁,平均44.5岁.耳部病变包括:胆脂瘤中耳炎12例(其中合并Hunt综合征1例),慢性单纯性化脓性中耳炎3例,急性中耳炎2例,Hunt综合征3例,理化因素损伤2例,中耳肿瘤2例.治疗前House·Brackman分级Ⅱ级3例,Ⅲ级5例,Ⅳ级13例,V级3例.手术行面神经减压术7例,病变切除+面神经减压术12例,病变切除未处理面神经4例,病变切除+切除面神经1例.术后随访1个月到8年,Ⅱ级以下者均随访6个月以上;恢复I级4例,Ⅱ级10例,Ⅲ级6例,Ⅳ级2例,V级l例,1例因癌症切除面神经为Ⅵ级.结论 及时去除病灶、行面神经减压是治疗耳源性面神经麻痹的有效方法,彻底地清理病灶是手术治疗耳源性面神经麻痹获得良好术后效果的基础.     

Neurophysiology of ischemic facial nerve paralysis in an animal model.

The establishment of an animal model for facial nerve paralysis is assuming increasing importance in clinical medicine and also in basic facial nerve research. We previously reported an animal model for ischemic facial nerve paralysis using selective vascular embolization through the internal maxillary and posterior auricular arteries in cats using Avitene which contains bovine microfibril collagen. In this paper, we determined the exact site of the lesion in established facial paralysis. A descending signal produced by direct stimulation to the contralateral motor cortex was able to elicit firing of the motor nucleus of the facial nerve, the extra-temporal portion of the peripheral nerve, and the orbicularis oris muscle. After achieving complete facial nerve paralysis, this descending signal was completely abolished within the temporal bone area, whereas peripheral facial nerve stimulation elicited a normal evoked electromyogram of the orbicularis oris muscle. The present results suggest that the site of the lesion of ischemic facial nerve paralysis produced by embolization in an animal model is within the temporal portion of the seventh nerve, and this animal model may lead to the advancement of future facial nerve research which cannot be conducted in humans.     

耳源性面瘫的治疗（附52例分析）

本文分析了５２例耳源性面瘫。面瘫的原因：急性中耳炎６例、慢性胆脂瘤型中耳炎或慢性骨疡型中耳炎２１例，乳突手术致面瘫２５例，其中迟发性面瘫１４例，即发性面瘫１１例。３６例通过手术治疗，包括单纯乳突凿开术、乳突根治术、面神经减压术或神经移植术。１６例行药物治疗。本组病例面神经功能完全恢复者３２例占６１．５％，部分恢复者１１例，未恢复者９例，并对耳源性面瘫的治疗方法的选择进行了讨论。     

Current Considerations in Neck Dissection

Conclusions. High resolution CT imaging can provide useful information about the pathological exposure of the mastoid portion of the facial nerve before mastoid surgery and can assess the injury site of the facial nerve after operation. Objectives. To evaluate the diagnostic value of high resolution CT scanning of pathological exposure of the mastoid portion of facial nerve and provide valuable information for otologic surgery, and to analyse the cause of facial nerve paralysis after operation. Materials and methods. Routine CT scanning was used to examine patients with chronic suppurative otitis media and external auditory canal cholesteatoma preoperatively by axial-transverse and coronal views. If there was any pathological exposure of the mastoid portion of the facial nerve on CT imaging, then this was compared with intraoperative findings. In addition, one patient who had suffered postoperative facial nerve paralysis was also examined by CT scanning to determine whether any pre-existing pathological exposure of facial nerve could be found. Results. Through routine CT scanning six patients with chronic suppurative otitis media and three patients with external auditory canal cholesteatoma were found to have pathological exposure of the mastoid portion of the facial nerve. Coronal views could more clearly show the size and the position of the exposure; the corresponding surgical findings (pathological exposure) for the facial nerve could be confirmed in all nine patients. CT imaging could also show that the patient who had suffered postoperative facial nerve paralysis did indeed have pre-existing pathological exposure of the mastoid portion of the facial nerve.     

A study of inflammatory mediators in the human tympanosclerotic middle ear

OBJECTIVE: To analyze immunocompetent cells as well as 2 factors involved in inflammation and also thought to be involved in bone remodeling-interleukin 6 (IL-6) and inducible nitric oxide synthase in the human middle ear, including the tympanic membrane. DESIGN: Biopsy specimens were obtained from the human middle ear and tympanic membrane during surgery. Using an immunohistochemical technique, the expression of macrophages, T cells, B cells, IL-6, and inducible nitric oxide synthase were analyzed. MATERIALS: Nine biopsy specimens from tympanic membranes in children having a transtympanic ventilation tube inserted as a treatment for secretory otitis media and 11 biopsy specimens from tympanosclerotic plaques from patients with chronic otitis media and tympanosclerosis. RESULTS: More positively stained specimens showing macrophages, B cells, and IL-6 were seen in the biopsy specimens from children with secretory otitis media compared with the biopsy specimens from patients with chronic otitis media and tympanosclerosis. The biopsy specimens from patients with chronic otitis media and tympanosclerosis more often showed positive stainings for inducible nitric oxide synthase than the biopsy specimens from children with secretory otitis media. The presence of IL-6 and inducible nitric oxide synthase was shown by staining to be mostly in the surface cells, while macrophages and B cells were stained deeper in the tissues, in connective tissue, or around sclerotic lesions. CONCLUSIONS: The 2 patient groups differed in antigen presentation so that macrophages, B cells, and IL-6 were labeled more frequently in patients with secretory otitis media, that is, an early phase of the disease. Inducible nitric oxide synthase was seen more frequently in the patients with already established tympanosclerosis in a later phase of the disease.     

Craniofacial morphology and otitis media with effusion in children

Otitis media with effusion (OME) affects 28-38% of pre-school children, and it occurs due to the dysfunction of the auditory tube. Anatomical development of the auditory tube depends on the craniofacial growth and development. Deviations of normal craniofacial morphology and growth using cephalometric studies, may predict the evolution of otitis. Our goal in this paper is to determine if there are differences in craniofacial morphology between children with adenoid enlargement, with and without otitis media with effusion. This is a prospective study in which the sample consisted of 67 children (male and female) from 5 to 10 years old. All patients presented chronic upper airway obstruction due to tonsil and adenoid enlargement (>80% degree of obstruction). Thirty-three patients presented otitis media with effusion, for more than 3 months and 34 did not. The latter composed the control group. Standardized lateral head radiographs were obtained for all subjects. Radiographs were taken with patient positioned by a cephalostat and stayed with mandibles in centric occlusion and lips at rest. Radiographs were digitalized and specific landmarks were identified using a computer program Radiocef 2003, 5th edition. Measurements, angles and lines were taken of the basicranium, maxilla and mandible according to the modified Ricketts analysis. In addition, facial height and facial axis were determined. Children with otitis media with effusion present differences in the morphology of the face, regarding these measures: N-S (anterior cranial base length), N-ANS (upper facial height), ANS-PNS (size of the hard palate), Po-Or.N-Pog (facial depth), Ba-N.Ptm-Gn (facial axis), Go-Me (mandibular length) and Vaia--Vaip (inferior pharyngeal airway).