Section 2

A 55 year year old gentleman below presented tot he ENT clinic. He is just about able to close his left eye. 

What is the diagnosis?

Left sided facial palsy

What is the classification of the above? What grade would this be?

  • House-Brackmann 
  • Grade III
  • Note
    • House Brackmann Classification
    • I – normal
    • II – mild asymmetry at rest, mild weakness, able to close eyes
    • III – facial asymmetry, moderate weakness, able to close eyes
    • IV – facial asymmetry, moderate-severe weakness, incomplete closure of the eye
    • V – facial asymmetry, severe weakness, slight flicker of movement
    • VI – total facial paralysis

How does this condition arise?

Reactivation of varicella zoster virus infection in the geniculate ganglion, of the facial nerve

Describe other symptoms might this patient also present with?

  • Abnormal sense of taste
  • Dry eye and mouth
  • Vesicles on tongue and/or hard palate
  • Otalgia
  • Hearing loss

What blood test could you perform to confirm this diagnosis?

Serology – varicella zoster IgG

Name two audiological tests you could perform?

  • Pure tone audiogram
  • Stapedial reflexes
  • Electroneurography

Describe three treatment options for this.

  • Steroids
  • Antivirals e.g. acyclovir
  • Eye protection – lubrication and tape
  • Analgesia
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