Face paralysis in woman after ear syringing: JAMA Case Report
A case report published in the journal JAMA Otolaryngology-Head & Neck Surgery describes an extremely rare occurrence in which a woman in her 70s developed permanent facial palsy and hearing loss after she went to a general physician for aural irrigation -- a routine procedure used for the removal of excess ear wax (cerumen), and foreign materials from the ear using liquid-filled syringe.
"This is a unique report of a rare but important complication of aural irrigation: tympanic membrane perforation and infection, with subsequent permanent facial palsy and mixed hearing loss, " Muhammad Nayeem Ahmed, University of Leeds, Leeds, United Kingdom, and colleagues write in their case report.
A nurse in the doctor's office tried twice to "flush" out the wax in each ear using a liquid-filled syringe. Soon after the procedure, the woman complained of pain and a loss of hearing in her left ear, along with a discharge containing pus and blood.
On examination by an ENT specialist, a severe infection of the outer part of the ear canal was discovered. Based on the condition, the woman was prescribed medicinal ear drops. However, three days after she presented to the emergency department with partial paralysis of the face on the left side including an inability to close the eyelid and weak movement of the mouth on smiling.
Further examination showed a perforated eardrum, and the woman received antibiotic therapy.
The ear infection did eventually clear up. But "three years later, the patient's left facial palsy and hearing loss" had still not completely healed, Ahmed's group said, even after interventions such as facial rehabilitation exercises and the use of botox injections.
The perforated eardrum also did not fully heal and the woman now wears a hearing aid, according to the report.
The report's authors stress that "serious complications of ear syringing have been only sporadically reported in the literature." Also, to their knowledge, this is only the second case ever reported of facial paralysis linked to the common procedure.
The first case did resolve over time, so the woman's unfortunate complication "is the first report in the literature, to our knowledge, of permanent facial palsy" in this context, Ahmed's team wrote.
And even though many people get their ear wax "flushed out" routinely, the common practice is still debated, the authors noted. In fact, recent clinical practice guidelines issued by the American Academy of Otolaryngology-Head and Neck Surgery acknowledge there's still not enough data to guide doctors in the use of the technique.
The British team stressed that while severe complications after aural irrigation are very rare, in this case, it "had serious, permanent, and life-changing consequences" for the woman involved.
For that reason, it's "important to document such cases because they contribute to the debate on the optimum method for treatment [of impacted ear wax]," the team explained.
The case report, "Permanent Facial Paralysis and Hearing Loss After Aural Irrigation," is published in the journal JAMA Otolaryngology-Head & Neck Surgery.