University of Wisconsin–Madison Medical College of Wisconsin

Facial-Stapedial Synkinesis Following Acute Idiopathic Facial Palsy

Michael Hutz, MD; Margaret Aasen; John Leonetti, MD

WMJ. 2020;119(3):211-214.

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Introduction: While most patients note a complete resolution of facial paralysis in Bell’s Palsy, up to 30% will have persistent facial weakness and develop synkinesis. All branches of the facial nerve are at risk for developing synkinesis, but stapedial synkinesis has rarely been reported in the literature.

Case Presentation: A 45-year-old man presented with sudden onset, complete right facial paralysis. One-and-a-half years later, he had persistent facial weakness and synkinesis. He noted persistent right aural fullness and hearing loss. Audiometry demonstrated facial-stapedial synkinesis.

Discussion: The patient was diagnosed with stapedial synkinesis based on audiometric findings by comparing his hearing at rest and with sustained facial mimetic movement. A literature review revealed 21 reported cases of this disorder.

Conclusions: Facial-stapedial synkinesis is an underdiagnosed phenomenon for patients recovering from idiopathic facial palsy. Patients who develop facial synkinesis also may have a component of stapedial synkinesis and should be referred to an otolaryngologist if they complain of any otologic symptoms, such as unilateral hearing loss or tinnitus. Definitive management involves surgical transection of the stapedial tendon.

Author Affiliations: Department of Otolaryngology – Head and Neck Surgery, Loyola University Medical Center, Maywood Ill (Hutz, Leonetti); Loyola University Chicago Stritch School of Medicine, Maywood Ill (Aasen).
Corresponding Author: Michael Hutz, MD, Loyola University Medical Center, Department of Otolaryngology – Head and Neck Surgery, 2160 S 1st Ave, Maywood IL 60153; phone 708.216.8523; email; ORCID ID 0000-0003-2921-6967.
Acknowledgements: Presented at the American Neurotology Society Meeting Facial Nerve Study Group Annual Meeting, Atlanta, Georgia, October 6, 2018.
Funding/Support: None declared.
Finacial Disclosures: None declared.
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