A 63-year-old with diabetes presents with severe otalgia, fever, a bulging tympanic membrane and a new complete lower-motor-neurone facial palsy. CT shows opacified mastoid air cells but no abscess. What is the best next management principle?
Facial palsy in acute otitis media is a complication requiring urgent specialist treatment, microbiological consideration and reassessment of drainage/source control rather than routine community management.
A. Oral analgesia and review in 48 hours: New facial dysfunction makes delay unsafe.
B. Urgent admission, intravenous treatment and senior ENT assessment for complicated otitis: Facial palsy in acute otitis media is a complication requiring urgent specialist treatment, microbiological consideration and reassessment of drainage/source control rather than routine community management.
C. Routine Bell-palsy treatment alone: The infected middle ear and systemic illness require treatment as the primary pathology.
D. Immediate mastoidectomy for every patient: Surgery may be needed for deterioration, coalescence or inadequate drainage, but imaging alone does not make it mandatory in every case.
E. Audiology after the infection settles: Audiology is useful later but cannot replace acute complication management.
If facial weakness occurred with a normal ear examination and no infective features, the diagnostic pathway would broaden to Bell palsy, Ramsay Hunt syndrome and central causes.
Draft Clinora educational material only; not official JCIE content, an accredited programme, or a substitute for local policy and specialist judgement.
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