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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.
This physical examination supports the diagnosis of:
Left facial palsy (FP)
Ramsay Hunt syndrome type 2 (RHS-2)
Can you describe the course of the facial nerve?
What is the next step in this baby's management?
Early discharge and oral antibiotic therapy
Admission to a paediatric department and intravenous antibiotic therapy
Reassurance and discharge
Surgical interventions (eg, drainage, myringotomy)
What is the prognosis of FP in a baby with AOM and mastoiditis?
Complete recovery in 80–100%
Complete recovery in 50–66%
Complete recovery in 20–33%
Complete recovery …
Competing interests None declared.
Patient consent Parental/guardian consent obtained.
Provenance and peer review Not commissioned; internally peer reviewed.
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