Caffrey Jason P, Adams Jason W, Costantino Isabel, Klepper Kristin, Kari Elina, Brown Lori A
School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
Department of Neurosciences, School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
J Med Case Rep. 2020 Nov 12;14(1):218. doi: 10.1186/s13256-020-02557-9.
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.
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.
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.
面部气压性轻瘫是一种第七颅神经麻痹，是由于压力增加沿神经通过中耳腔的行程压迫神经所致。这是一种罕见病症，最常见于气压伤环境中，尤其是水肺潜水和高空航空旅行。我们在此报告一例异常频繁发生的面部气压性轻瘫、检查及成功治疗的病例。
一名57岁的经常乘坐商业航班旅行的白种男性，有4年右侧面部麻痹和耳痛反复发作的病史，发作频率和严重程度均不断增加。发作几乎仅发生在飞机快速海拔变化期间，大多是上升过程中，但在汽车快速海拔变化时也会发生。自我治疗包括使用鼻用和口服减充血剂、鼻用皮质类固醇以及热敷。颞骨计算机断层扫描（CT）显示右侧鼓膜段可能存在骨质缺损；听力图和内耳道磁共振成像无异常。在诊断为面神经气压性轻瘫后，患者接受了鼓膜切开术，并在右鼓膜插入了一根咽鼓管通气管（PET）。尽管治疗后每周多次再次暴露于海拔变化中，但患者报告干预后6个月以上无症状。
对于反复出现面部气压性轻瘫发作的个体，及时插入PET可能是首选治疗方法。对这种罕见病症的教育可避免对受影响患者进行不必要的检查和治疗。未来的研究应探索其病理生理学和危险因素，比较治疗选择，并提供随访数据以优化对受影响患者的管理。
