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Facial palsy in a baby with acute otitis media
  1. Carolina D'Anna1,
  2. Mario Diplomatico2,
  3. Vincenzo Tipo1
  1. 1 Pediatric Emergency Department, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon di Napoli, Napoli, Italy
  2. 2 Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Napoli, Italy
  1. Correspondence to Dr Mario Diplomatico, Department of Woman, Child and of General and Specialized Surgery, Seconda Università degli Studi di Napoli, Via Luigi De Crecchio 2, Napoli 80138, Italy; mario.diplomatico{at}

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A 14-month-old girl was brought to the emergency department with fever for 3 days and inconsolable crying (figures 1 and 2). Physical examination revealed irritability and a red bulging right tympanic membrane (acute otitis media—AOM), without vesicles or ipsilateral parotid masses, no postauricular swelling/erythema, no auricular displacement and no palpable lymph nodes in the head/neck region. While crying, a left deviation of the mouth was evident, with incomplete closure of the right eye and slight movement of the forehead.


  1. This physical examination supports the diagnosis of:

    1. Left facial palsy (FP)

    2. Right FP

    3. Meningitis

    4. Ramsay Hunt syndrome type 2 (RHS-2)

    5. Acute mastoiditis

  2. Can you describe the course of the facial nerve?

  3. What is the next step in this baby's management?

    1. Early discharge and oral antibiotic therapy

    2. Admission to a paediatric department and intravenous antibiotic therapy

    3. Reassurance and discharge

    4. Surgical interventions (eg, drainage, myringotomy)

  4. What is the prognosis of FP in a baby with AOM and mastoiditis?

    1. Complete recovery in 80–100%

    2. Complete recovery in 50–66%

    3. Complete recovery in 20–33%

    4. Complete recovery …

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  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.