Navy diver with recurrent facial nerve baroparesis treated with eustachian tube balloon dilation

Abstract

Facial nerve baroparesis is a rare complication of middle ear barotrauma reported almost exclusively in overpressure events related to diving and flying. Until the development of Eustachian tube balloon dilation, no diving compatible options existed to effectively and safely prevent recurrence. We present a case of a U.S. Navy diver with a history of repeated ipsilateral facial nerve paresis that occurred during diving. The patient underwent Eustachian tube balloon dilation of the affected side. Following surgery, the patient completed a recompression chamber simulated dive that allowed the patient to return to diving. The patient has been symptom-free for 12 months following dilation.

A Systematic Review of Eustachian Tube Procedures for Baro‐challenge Eustachian Tube Dysfunction

“…The authors were contacted, but unfortunately, confirmation was not achieved. Ultimately, 11 publications were included in the systematic review 8,9,24,32–39 . Three publications were case reports and therefore were not included in the meta‐analysis 8,36,39 .…”

“…Ultimately, 11 publications were included in the systematic review. 8,9,24,[32][33][34][35][36][37][38][39] Three publications were case reports and therefore were not included in the meta-analysis. 8,36,39 A PRISMA diagram outlining the literature search is shown in Figure 1.…”

“…8,9,24,[32][33][34][35][36][37][38][39] Three publications were case reports and therefore were not included in the meta-analysis. 8,36,39 A PRISMA diagram outlining the literature search is shown in Figure 1. Critical appraisal of studies indicated a low risk of bias for the majority of included studies (Supplement 3).…”

An Effective Treatment for Recurrent Bilateral Facial Palsy in a Flight Attendant: A Case Report

“…The exact cause of facial baroparesis is not fully understood, but it is thought to involve facial neuropraxia triggered by compression of the facial nerve in the presence of heightened middle-ear pressure and a dehiscent facial canal [1][2][3][4][5]. Commercial aircraft typically operate at cruising altitudes between 30,000 and 40,000 feet, with cabin pressurization ranging from 12 psi to 11 psi, equivalent to an altitude of 5000 to 8000 feet [1].…”

“…This occurrence is presumed to be the result of increased middle-ear pressure with concurrent Eustachian tube dysfunction in the setting of a dehiscent facial canal wall. The pathophysiology of recurrent facial baroparesis is not fully understood, but the dehiscent facial canal wall in affected patients may expose the nerve to increased middle-ear pressure, causing transient ischemic neuropraxia [1][2][3][4][5]. We present a case of an airline stewardess with recurrent facial baroparesis, which was successfully treated with bilateral Eustachian tube balloon dilation, followed by bilateral myringotomy and Shepard grommet insertion.…”