Etiology is still unknown. Electrical testing follows the degeneration of the motor fibers. Steroids are indicated early in the course of the disease. The use of acyclovir is under investigation. Surgical decompression is accomplished via the middle fossa by an otologist-neurotologist.
Transmastoid decompression is no more efficacious than steroid therapy.
Infection Acute suppurative otitis media is caused by gram-positive cocci and Hemophilus influenza. Invasion into the facial canal through a dehiscence may evoke an inflammatory response with edema, compression, and ischemia resulting in facial weakness. Treatment includes myringotomy, appropriate antibiotics, and transmastoid decompression if degeneration progresses. Facial paralysis due to chronic otitis media requires tympanomastoidectomy for eradication of infection or cholesteatoma. Acyclovir is treatment of choice.