Summary
Background:
Facial nerve palsy is a rare complication of acute otitis media (AOM). The general understanding is that this complication has a bacterial cause although bacteria can be isolated from the middle ear only in approximately two-thirds of cases of AOM. Detection of viral agents from specimens obtained during myringotomy in patients with AOM suggests a possible role of viruses in the etiology of this disease.
Case presentations:
We studied 5 otherwise healthy 17- to 27-month-old children who were referred to the Department of Otorhinolaryngology and Cervicofacial Surgery from December 2012 to January 2016 because of AOM and ipsilateral facial nerve palsy. In all cases, serological tests were indicative of a primary Epstein–Barr virus (EBV) infection and no other causative pathogens were identified during hospitalization. In one patient, the technique of in situ hybridization (ISH) detected EBV-specific ribonucleic acid (RNA) sequences within tissue sections obtained during mastoidectomy.
Conclusions:
The aim of this article is to alert clinicians that AOM induced facial nerve palsy secondary to an acute EBV infection in the pediatric population is very likely more common than originally thought. To our knowledge until the present case series, only 2 cases of AOM induced facial nerve palsy secondary to an acute EBV infection have been reported and no cases of EBV infection proven by the ISH technique showing the presence of EBV-specific RNA sequences in patient’s tissue biopsies have been reported until now.
References
Hydén D, Akerlind B, Peebo M. Inner ear and facial nerve complications of acute otitis media with focus on bacteriology and virology. Acta Otolaryngol. 2006;126:460–6.
Bulut Y, Karlidag T, Seyrek A, Keles E, Toraman ZA. Presence of herpesviruses in middle ear fluid of children with otitis media with effusion. Pediatr Int. 2007;49:36–9.
Coddington CT, Isaacs JD, Siddiqui AQ, Andrews TC. Neurological picture. Bilateral facial nerve palsy associated with Epstein-Barr virus infection. J Neurol Neurosurg Psychiatr. 2010;81:1155–6.
Diedler J, Rieger S, Koch A, Parthe-Peterhans S, Schwaninger M. Bilateral facial palsy: Epstein-Barr virus, not Lyme disease. Eur J Neurol. 2006;13:1029–30.
Hess RD. Routine Epstein-Barr Virus Diagnostics from the Laboratory Perspective: Still Challenging after 35 Years. J Clin Microbiol. 2004;42:3381–7.
Lupo J, Germi R, Semenova T, Buisson M, Seigneurin JM, Morand P. Performance of Two Commercially Available Automated Immunoassays for the Determination of Epstein-Barr Virus Serological Status. Clin Vaccine Immunol. 2012;19:929–34.
De Paschale M, Clerici P. Serological diagnosis of Epstein-Barr virus infection: Problems and solutions. World J Virol. 2012;1:31–43.
De Paschale M, Agrappi C, Manco MT, Mirri P, Viganò EF, Clerici P. Seroepidemiology of EBV and interpretation of the “isolated VCA IgG” pattern. J Med Virol. 2009;81:325–31.
Costa E, Tormo N, Clari MÁ, Bravo D, Muñoz-Cobo B, Navarro D. Performance of the Epstein-Barr Virus and Herpes Simplex Virus Immunoglobulin M Assays on the Liaison Platform with Sera from Patients Displaying Acute Parvovirus B19 Infection. Clin Vaccine Immunol. 2009;16:1247–8.
Luderer R, Kok M, Niesters HGM, Schuurman R, de Weerdt O, Thijsen SFT. Real-time Epstein-Barr virus PCR for the diagnosis of primary EBV infections and EBV reactivation. Mol Diagn. 2005;9:195–200.
Michel RG, Pope TH, Patterson CN. Infectious mononucleosis, mastoiditis, and facial paralysis. Arch Otolaryngol. 1975;101:486–9.
Wilson C, Grant CC. Picture of the month. Facial nerve palsy secondary to Epstein-Barr virus infection. Arch Pediatr Adolesc Med. 1997;151:739–40.
Grose C, Henle W, Henle G, Feorino PM. Primary Epstein–Barr-Virus Infections in Acute Neurologic Diseases. N Engl J Med. 1975;292:392–5.
Yabuki S, Kazahaya Y, Kubonishi I. Epstein-Barr virus antibodies in neurological diseases. Folia Psychiatr Neurol Jpn. 1985;39:85–93.
Andersson J, Sterner G. A 16-month-old boy with infectious mononucleosis, parotitis and Bell’s palsy. Acta Paediatr Scand. 1985;74:629–32.
Timár L, Budai J, Gerö A, Lakos A, Rapi K. Rare complications and unusual syndromes associated with Epstein-Barr virus. Pediatr Infect Dis. 1985;4:212–3.
Long CM, Kerschner JE. Parotid mass: Epstein–Barr virus and facial paralysis. Int J Pediatr Otorhinolaryngol. 2001;59:143–6.
Terada K, Niizuma T, Kosaka Y, Inoue M, Ogita S, Kataoka N. Bilateral facial nerve palsy associated with Epstein-Barr virus infection with a review of the literature. Scand. J Infect Dis. 2004;36:75–7.
Kanerva M, Jääskeläinen AJ, Suvela M, Piiparinen H, Vaheri A, Pitkäranta A. Human herpesvirus-6 and -7 DNA in cerebrospinal fluid of facial palsy patients. Acta Otolaryngol. 2008;128:460–4.
Kennedy M, Apostolova M. A rare case of infectious mononucleosis complicated by guillain-barre syndrome. Neurol Int. 2013;5:20–2.
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K. Vogelnik and A. Matos declare that they have no competing interests.
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Vogelnik, K., Matos, A. Facial nerve palsy secondary to Epstein–Barr virus infection of the middle ear in pediatric population may be more common than we think. Wien Klin Wochenschr 129, 844–847 (2017). https://doi.org/10.1007/s00508-017-1259-y
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DOI: https://doi.org/10.1007/s00508-017-1259-y