Aetiology:
Pressure by cholesteatoma on the facial nerve in the middle ear or mastoid.
Clinical features:
Presents as partial or complete lower motor neurone facial paralysis with evidence of chronic middle ear disease on otoscopy.
Management:
Treatment is by immediate surgical decompression of the facial nerve via a mastoidectomy operation.
Suppurative labyrinthitis
Aetiology:
Follows erosion of the bony labyrinth most commonly over the lateral semicircular canal. In the early stages compression of the air in the external meatus causes vertigo from mechanism stimulation of the labyrinth (fistula test). Later purulent infection in the inner ear causes severe vertigo and sensorineural deafness.
Management:
Treatment is by intravenous antibiotics and eradication of cholesteatoma via mastoidectomy.
Gradenigo’s syndrome
Otorrhoea is associated with pain behind the eye and diplopia, caused by fifth and sixth nerve irritation resulting from air cell infection at the petrous apex.
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