Successful treatment of highly recurrent facial baroparesis in a frequent high-altitude traveler: a case report

Abstract

Background 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. Case presentation 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. Conclusions 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.

Recommendations for traveling to altitude with neurological disorders

“…40,127,128 Facial baroparesis (VII cranial nerve palsy), typically due to the increased pressure compressing the nerve in the middle ear cavity, has been reported in 11 published case report due to HA air travel or mountain trekking (4300 m reached in 6 days). 129,130 Hypoglossal nerve palsy probably due to increased pressure in the hypoglossal foramen has been reported (3500 m reached from 2500 in 3 days). 129 Neurodegenerative disorders Multiple sclerosis.…”

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

“…The remaining 10 cases resolved spontaneously, requiring no medical intervention. All cases that received medical intervention reported successful outcomes [ 2 - 5 ]. In our case, we performed bilateral Eustachian tube balloon dilatation and myringotomy with grommet insertion.…”

“…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.…”