Diseases of The Middle Ear
Treatment of choice for CSOM with vertigo and facial nerve palsy is: (DNB June 2010)
|A||Antibiotics and labyrinthine sedative|
|C||Immediate mastoid exploration|
Facial Palsy and CSOM
In CSOM, facial palsy may be due to erosion of fallopian canal by cholesteatoma (which erodes fallopian canal) osteitis, or demin¬eralization. The treatment should be urgent mastoid exploration, with decompression of the facial nerve in the fallopain canal.
a. However, the scenario is not the same in ASOM. An acute inflammatory process cannot effectively erode the bony falopian canal within the short period of time. Hence, the only possibility in a patient with ASOM to develop facial palsy is the presence of a congenitally dehiscent fallopian canal (facial nerve without a bony canal), which is the commonest congenital maliformation of temporal bone .
b. Thus in this case the treatment is myringotomy to relieve pressure on the exposed nerve or sometimes cotical mastoidectomy.