Hostname: page-component-848d4c4894-75dct Total loading time: 0 Render date: 2024-05-08T05:38:52.651Z Has data issue: false hasContentIssue false

Facial nerve baroparesis during airflight: a case report and literature review

Published online by Cambridge University Press:  09 December 2020

M Alwan*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Monash Health, Melbourne, Australia
M Gordan
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Monash Health, Melbourne, Australia
*
Author for correspondence: Dr M Alwan, Department of Otolaryngology, Head and Neck Surgery, Monash Health, 823–865 Centre Road, Bentleigh East, Melbourne 3165, Australia E-mail: ENT_Research@monashhealth.org Fax: +61 992 88052

Abstract

Background

Facial nerve baroparesis is a rare phenomenon which has been reported during flight. It is thought to occur due to ischaemic neuropraxia on the facial nerve as middle-ear pressure increases in the presence of Eustachian tube dysfunction and force is transmitted through a dehiscent facial nerve canal.

Method

This study presents an aviation-associated, right-sided facial nerve palsy as well as presenting the results of a systematic review that was performed on the available literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text articles from Medline, PubMed and Embase were used, as well as associated reference lists. This study systematically reviews the literature to discuss presentation, investigations performed and an approach to management of this rare condition.

Results

This study identified 23 cases in the literature (including the case presented in this study) of facial nerve baroparesis.

Conclusion

Facial nerve baroparesis is a mostly temporary rare phenomenon that can be managed effectively with ventilation tube insertion. In the event of long-standing facial nerve palsy after descent of the aircraft, urgent myringotomy should be performed to prevent permanent facial nerve damage.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited, 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Dr M Alwan takes responsibility for the integrity of the content of the paper

References

Molvaer, OI, Eidsvik, S. Facial baroparesis: a review. Undersea Biomed Res 1987;14:277–95Google ScholarPubMed
Bennett, DR, Liske, E. Transient facial paralysis during ascent to altitude. Neurology 1967;17:194–8CrossRefGoogle ScholarPubMed
Rutten, H, Kunst, H. Facial nerve palsy in aviation facial baroparesis. J Int Adv Otol 2010;6:277–81Google Scholar
Ardehali, MM, Yazdani, N, Heidarali, M. Transient facial nerve baroparesis: case report. Pak J Biol Sci 2009;12:476–9CrossRefGoogle ScholarPubMed
Cumming, B, Matchett, I, Meller, C, Saxby, A. High altitude alternobaric facial palsy: case series and systematic review of the literature. Otol Neurotol 2019;40:1378–85CrossRefGoogle ScholarPubMed
Krywko, DM, Clare, DT, Orabi, M. Facial baroparesis mimicking stroke. Clin Pract Cases Emerg Med 2018;2:136–8CrossRefGoogle ScholarPubMed
White, R, Shackleton, D. Plane palsy: a case of transient facial weakness during an aircraft flight. BMJ Case Rep 2018:bcr2018224593CrossRefGoogle ScholarPubMed
Grossman, A, Ulanovski, D, Barenboim, E, Azaria, B, Goldstein, L. Facial nerve palsy aboard a commercial aircraft. Aviat Space Environ Med 2004;75:1075–6Google ScholarPubMed
Berghaus, A. Transient facial nerve paralysis during flight [in German]. HNO 2001;49:927–9CrossRefGoogle Scholar
Cheng, TZ, Kaylie, DM. Recurrent and progressive facial baroparesis on flying relieved by Eustachian tube dilation. Ann Otol Rhinol Laryngol 2019;128:778–81CrossRefGoogle ScholarPubMed
Kung, RW, Roche, JP, Gantz, BJ. Postoperative facial baroparesis while flying: a rare complication of decompressing a facial nerve schwannoma. JAMA Otolaryngol Head Neck Surg 2018;144:457–9CrossRefGoogle ScholarPubMed
Cada, Z, Hrubá, S, Jerabek, J, Cerny, R, Kluh, J, Balatkova, Z et al. Peripheral facial paresis linked to air travel. Ceska Slovenska Neurol Neurochir 2017; 80:724–5CrossRefGoogle Scholar
Vivekananda, U, Omer, S. Transient facial weakness whilst on a flight. J Neurol Sci 2017;375:299300CrossRefGoogle ScholarPubMed
Wimmer, MS, Ali, TY. Transient unilateral facial nerve baroparesis with vertigo on ascent in the F-16CM. Aerosp Med Hum Perform 2016;87:141–3CrossRefGoogle ScholarPubMed
Ah-See, KL, Shakeel, M, Maini, SK, Hussain, SS. Facial paralysis during air travel: case series and literature review. J Laryngol Otol 2012;126:1063–5CrossRefGoogle ScholarPubMed
Motamed, M, Pau, H, Daudia, A, Narula, A. Recurrent facial nerve palsy on flying. J Laryngol Otol 2000;114:704–5CrossRefGoogle ScholarPubMed
Woodhead, CJ. Recurrent facial palsy at high altitude. J Laryngol Otol 1988;102:718–9CrossRefGoogle ScholarPubMed
Silverstein, H. Facial paralysis associated with air flight. Am J Otol 1986;7:394–5Google ScholarPubMed
Anonymous. The collected letters of the international correspondence society of ophthalmologists and otolaryngologists. New Orleans; Report No. 1978;24Google Scholar
D'Andrea, CMJ, Frederik, S. Peripheral facial paralysis of dysbaric origin [in French]. Presse Med 2008;37:643–7Google Scholar
Mirza, S, Richardson, H. Otic barotrauma from air travel. J Laryngol Otol 2005;119:366–70CrossRefGoogle ScholarPubMed
Brown, TP. Middle ear symptoms while flying. Ways to prevent a severe outcome. Postgrad Med 1994;96:135–7, 141–2CrossRefGoogle ScholarPubMed
Whelan, TR. Facial nerve palsy associated with underwater barotrauma. Postgrad Med J 1990;66:465–6CrossRefGoogle ScholarPubMed
King, PF. The Eustachian tube and its significance in flight. J Laryngol Otol 1979;93:659–78CrossRefGoogle ScholarPubMed
Eidsvik, S, Molvaer, OI. Facial baroparesis: a report of five cases. Undersea Biomed Res 1985;12:459–63Google ScholarPubMed
Roffman, GD, Babin, RW, Ryu, JH. The effect of blood pressure on compression-induced facial nerve neuropraxia in the cat. Otolaryngol Head Neck Surg 1981;89:629–37CrossRefGoogle ScholarPubMed
Nagai, H, Nakashima, T, Suzuki, T, Yanagita, N. Effect of increased middle ear pressure on blood flow to the middle ear, inner ear and facial nerve in guinea pigs. Acta Otolaryngol 1996;116:439–42CrossRefGoogle ScholarPubMed
Moreano, EH, Paparella, MM, Zelterman, D, Goycoolea, MV. Prevalence of carotid canal dehiscence in the human middle ear: a report of 1000 temporal bones. Laryngoscope 1994;104:612–18CrossRefGoogle ScholarPubMed
Baxter, A. Dehiscence of the fallopian canal. An anatomical study. J Laryngol Otol 1971;85:587–94CrossRefGoogle ScholarPubMed
Kida, K. Developmental studies on the petrous part of the human temporal bone--special references to the morphogenesis of the facial nerve canal [in Japanese]. Hokkaido Igaku Zasshi 1996;71:205–16Google Scholar
Keskin, S, Çetin, H, Töre, HG. The correlation of temporal bone CT with surgery findings in evaluation of chronic inflammatory diseases of the middle ear. Eur J Gen Med 2011;8:2430Google Scholar
Fuse, T, Tada, Y, Aoyagi, M, Sugai, Y. CT detection of facial canal dehiscence and semicircular canal fistula: comparison with surgical findings. J Comput Assist Tomogr 1996;20:221–4CrossRefGoogle ScholarPubMed
Westerman, ST, Fine, MB, Gilbert, L. Aerotitis: cause, prevention, and treatment. J Am Osteopath Assoc 1990;90:926–8Google ScholarPubMed