Acute otitis media complicated by peripheral facial nerve palsy in an adult: A case report.

Acute otitis media (AOM) is a common infection, whereas peripheral facial nerve palsy is an uncommon extracranial complication in the post-antibiotic era. We report the case of a 53-year-old immunocompetent man who developed acute suppurative otitis media complicated by ipsilateral peripheral facial nerve palsy following an upper respiratory tract infection. The illness began with sore throat and cough during Hajj and progressed to severe right-sided otalgia, followed by complete right lower motor neuron facial weakness despite sequential empirical oral antibiotics. On return to Pakistan, otoscopy demonstrated a bulging, pulsating opaque tympanic membrane. Laboratory investigations revealed neutrophilic leukocytosis with normal glycated hemoglobin. Computed tomography of the temporal bones showed acute right oto-mastoiditis with middle ear opacification, an air-fluid level within the mastoid, and subtle possible erosive change along the lateral facial nerve canal without intracranial extension. The patient was treated conservatively with intravenous ceftriaxone, oral corticosteroids, and early structured facial physiotherapy. Facial nerve function improved by approximately 70% within 10 days and recovered completely by day 25 without surgical intervention. This case highlights the importance of recognizing facial nerve palsy as a rare but potentially reversible complication of AOM. It also emphasizes the increased burden of upper respiratory tract infections during mass gatherings and the need for early otologic and neurological evaluation in pilgrims presenting with persistent otalgia or new facial asymmetry to facilitate timely treatment and favorable outcomes.