Facial Nerve Paralysis: Addressing Hearing Issues and Next Steps

Facial nerve paralysis with impaired hearing?

Hello, doctor.
I have been experiencing facial nerve paralysis for over a month now.
My facial asymmetry has improved, but I still have strange sensations in my ear, difficulty hearing, and I am very sensitive to loud and sharp sounds.
Additionally, the tip of my tongue feels a bit numb.
I'm unsure if I should undergo further examinations and whether I should see an otolaryngologist or a neurologist.
Could you please advise me on what to do?

Zhen, 20~29 year old female. Ask Date: 2016/05/03

Dr. Jiang Junyi reply Neurology

Hello, based on your description, 80% of patients with facial nerve paralysis will recover within 4 to 6 weeks, while a small portion may experience very slow recovery, potentially taking over 2 years, and often with incomplete recovery.
During the acute phase, treatment includes medications such as corticosteroids, active vitamins, blood circulation enhancers, and physical therapies like massage, laser therapy, infrared irradiation, shortwave therapy, and facial muscle exercises.
To enhance treatment effectiveness, self-care is also very important: a.
Protect the eyes, using an eye patch if necessary, to prevent corneal damage.
b.
Maintain a balanced diet and avoid spicy foods; ensure adequate rest and avoid staying up late.
c.
Consider supplementing with B vitamins as they may aid in nerve repair.
It is advisable to consult a neurologist or a rehabilitation physician for further evaluation and treatment.
Wishing you good health, peace, and happiness.

Reply Date: 2016/05/03

More Info

Facial nerve paralysis, commonly known as Bell's palsy, can lead to a variety of symptoms that extend beyond facial muscle weakness. In your case, it seems that while you are experiencing some recovery in facial symmetry, you are still facing auditory issues and altered sensations in your tongue. These symptoms can be quite distressing and may indicate that further evaluation is necessary.

Understanding Your Symptoms
1. Auditory Issues: The sensation of muffled hearing or discomfort with loud sounds can be attributed to the involvement of the facial nerve (cranial nerve VII) and the vestibulocochlear nerve (cranial nerve VIII). The facial nerve not only controls facial expressions but also has a role in the function of the middle ear muscles, which help dampen sounds. If this nerve is affected, it can lead to hyperacusis (increased sensitivity to normal environmental sounds) or other auditory disturbances.

2. Tongue Sensation: The tingling or numb sensation in your tongue may be related to the facial nerve's influence on taste sensation. The chorda tympani branch of the facial nerve carries taste sensations from the anterior two-thirds of the tongue. If this nerve is compromised, it can lead to altered taste perception or sensations of numbness.

Next Steps
Given your ongoing symptoms, it is advisable to seek further evaluation. Here are some recommendations:
1. Consult an Ear, Nose, and Throat (ENT) Specialist: An ENT specialist can assess your auditory function and determine if there are any underlying issues with your hearing or the structures of your ear that need to be addressed. They may conduct hearing tests and evaluate the middle ear's function.

2. Neurology Consultation: Since your symptoms are also neurological in nature, a consultation with a neurologist would be beneficial. They can evaluate the extent of facial nerve involvement and assess any potential complications or associated conditions that may be contributing to your symptoms.

3. Imaging Studies: Depending on the findings from your consultations, your doctors may recommend imaging studies, such as an MRI or CT scan, to rule out any structural abnormalities or lesions affecting the facial or auditory nerves.

4. Rehabilitation: Continue with rehabilitation therapies, including physical therapy focused on facial exercises. This can help improve muscle coordination and strength, which may also alleviate some of the auditory and sensory symptoms.

5. Medications: If your symptoms are severe, your healthcare provider may consider medications to help manage pain or discomfort, as well as to address any inflammation that may be affecting nerve function.

Conclusion
Facial nerve paralysis can have a significant impact on quality of life, and it is important to address all associated symptoms comprehensively. By consulting with both an ENT specialist and a neurologist, you can gain a clearer understanding of your condition and develop a tailored treatment plan. Remember that recovery can take time, and ongoing support from healthcare professionals is essential in navigating the complexities of your symptoms. Stay proactive in your healthcare, and do not hesitate to seek help when needed.

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