Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • single episode
  • unilateral
  • absence of constitutional symptoms
  • involvement of all nerve branches
  • keratoconjunctivitis sicca
  • pain
  • synkinesis

Other diagnostic factors

  • any age
  • hyperacusis
  • dysgeusia

Risk factors

  • upper respiratory tract infection
  • intranasal influenza vaccination
  • black or Hispanic ancestry
  • arid/cold climate
  • hypertension
  • FHx of Bell palsy
  • pregnancy
  • diabetes

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
  • electroneuronography (ENoG) (evoked electromyography - eEMG)
  • needle electromyography (EMG)
  • serology for Borrelia burgdorferi
Full details

Investigations to consider

  • pure-tone audiometry
  • tympanometry and stapedius reflex
  • MRI (gadolinium-enhanced fine-cut of facial nerve course)
  • CT (fine-cut, non-enhanced)
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Professor of Otology and Laryngology

Director, Division of Facial Plastic and Reconstructive Surgery and Director, Facial Nerve Center

President, Sir Charles Bell Society

Massachusetts Eye and Ear Infirmary and Harvard Medical School

Boston

MA

Disclosures

TH declares that she has no competing interests.

Fellow

Division of Facial Plastic and Reconstructive Surgery

Massachusetts Eye and Ear Infirmary

Boston

MA

Disclosures

NJ declares that he has no competing interests.

Dr Tessa Hadlock and Dr Nathan Jowett would like to gratefully acknowledge Dr Vishnu Madhok, Dr Iain Swan, Dr Pauline Lockhart, Dr Michael Norbury, and Dr John Gail Neely, previous contributors to this monograph. VM, IS, PL, MN, and JGN declare that they have no competing interests.

Peer reviewers VIEW ALL

Consultant Neurologist

Barts Health NHS Trust

London

UK

Disclosures

GE is involved in a number of clinical trials on multiple sclerosis sponsored by Genzyme, Roche, Teva, Novartis, Biogen, as well as one funded by the MRC. He is also involved in clinical trials sponsored by Allergan, NMT Medical, GlaxoSmithKline (GSK), Bristol-Myers, the UK's Parkinson's Disease Research Group, and Pharmacia. In addition, he has attended lectures, conferences and symposia with the following companies - GSK, Astra Zeneca, MSD, Almirall, Pfizer, Menarini, Allergan, Biogen, Teva, Conference Plus, Infomed, BMJ.

Major

US Air Force

MC Program Director

Department of Neurology

MMCN

Wilford Hall Medical Center

Lackland Air Force Base

TX

Disclosures

PG declares that he has no competing interests.

Consultant in ENT/Thyroid Surgery

Arrowe Park Hospital

Upton

Wirral

UK

Disclosures

VS declares that he has no competing interests.

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