acyclovir and Otitis-Media

Facial palsy with infectious mononucleosis, although well-recognized, is rare in children, and its pathogenesis is uncertain. To our knowledge there has been no previous report describing varicella-zoster virus reactivation as a cause of facial palsy associated with infectious mononucleosis. We report such a patient in whom serology showed reactivation of varicella-zoster virus.

Topics: Acyclovir; Child, Preschool; Drug Therapy, Combination; Facial Paralysis; Follow-Up Studies; Herpesvirus 3, Human; Humans; Infectious Mononucleosis; Male; Otitis Media; Prednisone; Risk Assessment; Treatment Outcome; Virus Activation

Medical treatment for facial palsy includes an accurate diagnosis and reliable estimate of prognosis as well as appropriate medication. Cranial polyneuritis (Bell's palsy and Ramsay Hunt syndrome), the most common cause of facial palsy, is an inflammatory, autoimmune, demyelinating disease best treated by parenteral steroids without surgical intervention. The antiviral agent acyclovir is now being tested as an adjunct to or replacement for steroid therapy. Trauma, the second most common cause of facial palsy, is often treated with steroids, but no controlled study has ever been performed. However, animal experiments clearly demonstrate that steroid treatment of a compressed facial nerve accelerates repair of the mechanical injury and decreases time of recovery. Acute otitis media with facial palsy is best treated with myringotomy, appropriate antibiotics, and steroid therapy. The use of steroids with antibiotics improves the resolution of middle ear exudate fourfold, compared with the use of antibiotics alone. Other treatment modes in selected cases are discussed. Physiotherapy in the form of electrical stimulation of the facial muscles is not advised.

Topics: Acyclovir; Animals; Autoimmune Diseases; Cranial Nerve Diseases; Diagnosis, Differential; Facial Paralysis; Guinea Pigs; Herpes Zoster; Humans; Methylprednisolone; Otitis Media; Polyneuropathies; Prednisone; Prognosis