Facial-Stapedial Synkinesis Following Acute Idiopathic Facial Palsy.

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.