Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report
Abstract Background Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-alt...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | Journal of Medical Case Reports |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13256-020-02557-9 |
| _version_ | 1819172666613956608 |
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| author | Jason P. Caffrey Jason W. Adams Isabel Costantino Kristin Klepper Elina Kari Lori A. Brown |
| author_facet | Jason P. Caffrey Jason W. Adams Isabel Costantino Kristin Klepper Elina Kari Lori A. Brown |
| author_sort | Jason P. Caffrey |
| collection | DOAJ |
| description | Abstract Background Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment. Case presentation A 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention. Conclusions Prompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients. |
| first_indexed | 2024-12-22T20:10:49Z |
| format | Article |
| id | doaj.art-eb25f40a69954ac78fbc62839841b868 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-22T20:10:49Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-eb25f40a69954ac78fbc62839841b8682022-12-21T18:14:02ZengBMCJournal of Medical Case Reports1752-19472020-11-011411410.1186/s13256-020-02557-9Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case reportJason P. Caffrey0Jason W. Adams1Isabel Costantino2Kristin Klepper3Elina Kari4Lori A. Brown5School of Medicine, University of CaliforniaSchool of Medicine, University of CaliforniaSchool of Medicine, University of CaliforniaSchool of Medicine, University of CaliforniaSchool of Medicine, University of CaliforniaSchool of Medicine, University of CaliforniaAbstract Background Facial baroparesis is a palsy of the seventh cranial nerve resulting from increased pressure compressing the nerve along its course through the middle ear cavity. It is a rare condition, most commonly reported in barotraumatic environments, in particular scuba diving and high-altitude air travel. We report here an unusual case of highly frequent baroparesis, workup, and successful treatment. Case presentation A 57-year-old Caucasian male frequent commercial airline traveler presented with a 4-year history of recurrent episodes of right-sided facial paralysis and otalgia, increasing in both frequency and severity. Incidents occurred almost exclusively during rapid altitude changes in aircraft, mostly ascent, but also during rapid altitude change in an automobile. Self-treatment included nasal and oral decongestants, nasal corticosteroids, and warm packs. Temporal bone computed tomography (CT) scan revealed possible right-sided dehiscence of the tympanic bone segment; audiogram and magnetic resonance imaging of the internal auditory canals were unremarkable. After a diagnosis of facial nerve baroparesis was made, the patient underwent myringotomy with insertion of a pressure equalization tube (PET) into the right tympanic membrane. Despite re-exposure to altitude change multiple times weekly post-treatment, the patient reported being symptom-free for more than 6 months following intervention. Conclusions Prompt PET insertion may represent the preferred treatment for individuals who suffer recurrent episodes of facial baroparesis. Education regarding this rare condition may prevent unnecessary testing and treatment of affected patients. Future studies should explore the pathophysiology and risk factors, compare therapeutic options, and provide follow-up data to optimize the management of affected patients.http://link.springer.com/article/10.1186/s13256-020-02557-9Altitude and aviation medicineBaroparesisCranial nerve traumaFacial nerve palsyFacial paralysis |
| spellingShingle | Jason P. Caffrey Jason W. Adams Isabel Costantino Kristin Klepper Elina Kari Lori A. Brown Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report Journal of Medical Case Reports Altitude and aviation medicine Baroparesis Cranial nerve trauma Facial nerve palsy Facial paralysis |
| title | Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report |
| title_full | Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report |
| title_fullStr | Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report |
| title_full_unstemmed | Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report |
| title_short | Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report |
| title_sort | successful treatment of highly recurrent facial baroparesis in a frequent high altitude traveler a case report |
| topic | Altitude and aviation medicine Baroparesis Cranial nerve trauma Facial nerve palsy Facial paralysis |
| url | http://link.springer.com/article/10.1186/s13256-020-02557-9 |
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