Facial nerve palsy complicating paediatric acute otitis media: a clinical observational study and systematic review

Introduction

Facial nerve palsy (FNP) is the most common cranial nerve dysfunction in paediatric patients, with potential long-term effects on vision, feeding, cosmesis, psychological wellbeing, and quality of life (1). Infectious aetiology for FNP accounts for 12–36% of paediatric cases (1).

Acute otitis media (AOM) is a common childhood infection, with up to 80% of children experiencing at least one episode before school age (2). While usually self-limiting, rare complications do occur including mastoiditis, FNP, meningitis, intracranial abscess, and dural venous sinus thrombosis (3).

Historically, AOM with FNP without other pathology had an incidence of approximately 0.5–0.7%, but following the introduction of antibiotics and vaccinations, the incidence is extremely rare now at 0.005% (4,5). FNP in AOM is most frequently seen in children under 2 years of age (6). In the absence of mastoiditis or other ear pathology, the pathogenesis of FNP in AOM is not fully understood but thought to involve middle ear inflammation, oedema, ischaemia of the nerve, or infection spreading through dehiscence of the fallopian canal (4,7).

Management of FNP complicating AOM typically involves some or all the following: intravenous broad-spectrum antibiotics, grommet insertion with topical therapy, and systemic steroids (8-10). Given the scarcity of this presentation, there is very little evidence guiding management and there is no published treatment consensus (2,4,5).

This study aimed to describe the clinical presentation, management, and outcomes of paediatric FNP secondary to AOM, and to compare these findings with published literature.

Methods

Clinical study

The study is reported according to the STROBE reporting guidelines (available at https://www.theajo.com/article/view/10.21037/ajo-2025-1-80/rc). Our retrospective cohort study evaluated outcomes for all children <18 years of age presenting to a major tertiary paediatric hospital, Queensland Children’s Hospital (QCH) with an acute FNP arising from AOM between January 2015 and December 2024. Patients with more complicated ear disease were excluded from the cohort, including those with features of cholesteatoma or mastoiditis (ear proptosis, post auricular swelling, erythema, abscess, or other intracranial mastoiditis complications).

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee as a Quality Assurance project exempt from ethical review (HREC: EX/2025/QCHQ/120401), and individual consent for this retrospective analysis was waived.

Patients were identified in the QCH electronic medical record system via operative coding for emergency grommet insertion +/− mastoidectomy in January 2025. Figure 1 describes exclusion criteria applied at manual chart review to ensure only children with FNP due to AOM were included. Children managed non-operatively were not identified.

Figure 1 Study inclusion and exclusion flow diagram for paediatric patients with facial nerve palsy secondary to acute otitis media. AOM, acute otitis media; FNP, facial nerve palsy.

Clinical parameters recorded were age, gender, clinical history during admission, relevant past medical history, examination findings, imaging, microbiological results from any samples taken during admission, medical treatment before and during admission, surgical procedure(s) during admission. Facial nerve function was graded using the House-Brackmann (HB) score (Table 1). This scale was selected as it is the most widely adopted and validated clinical scale for assessing facial nerve function, facilitating direct comparison with previously published series (11). The cohort was divided by FNP severity using the clinically relevant finding of eye closure: milder FNP with HB 2–3 and more severe FNP with HB 4–6. Facial nerve function was assessed by the treating otolaryngologist at each clinical encounter with either a documented overall HB score or a description of facial nerve function. Recovery data were extracted retrospectively from documented clinical assessments in the medical record.

Statistical analysis

De-identified data was stored on Queensland Health computers with a separate key for re-identification. Statistical analysis was performed using R (version 4.4.2) with dplyr, tidyr and ggplot2 packages and GraphPad Prism 10, with support from University of Queensland’s Data Science Collaborative Research Group. Data deviated from a normal distribution (Shapiro-Wilk, P<0.01 and Q-Q plot), therefore non-parametric tests were used. Continuous data was represented as median with inter quartile range, and comparisons were made using Mann-Whitney U testing and Spearman rank correlation, with P value <0.05 considered statistically significant. Effect sizes via Hodges-Lehmann estimator and 95% confidence intervals (CIs) were calculated for relevant data. Categorical variables were reported as frequencies and percentages, while associations were explored using Fisher’s exact test, with P value <0.05 considered statistically significant.

Systematic review

A systematic literature review was conducted on 31/10/2025 to identify peer-reviewed studies of AOM in children <18 years of age reporting FNP outcomes using PubMed and Scopus databases. The search period was 1976 to 2025 and articles were limited to English language. Full details of the literature review performed are provided in Appendix 1. Figure 2 is the PRISMA flow diagram of study selection. Overall, 259 possible studies were identified, 21 full-text articles were assessed for eligibility, and after manual evaluation eight studies were included. One study was added after interrogating the reference lists of all included studies. The review protocol was not prospectively registered.

Figure 2 PRISMA flow diagram showing how studies were selected for the systematic review.

Methodological quality of included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tool for case series. Single reviewer appraised each study. Studies were not excluded on the quality assessment alone; appraisal findings were considered during the interpretation of the results.

The following data where available was extracted from each study based on published data: author, year, number of paediatric patients in study, median age where provided (or mean), median HB status where provided (or mean), details of medical treatment, surgeries performed, proportion of cohort where facial nerve function normalised, and mean time to complete facial nerve function recovery. Due to clinical and methodological heterogeneity across included studies, statistical pooling was not appropriate, and therefore a descriptive synthesis of the data from each paper and the current study was performed. Study selection and data extraction was performed independently by a single reviewer.

Results

Demographics

Over the 10-year study period, 26 patients were treated at QCH for FNP due to AOM in the absence of other ear pathologies (Table 2). Younger children and males were more commonly affected: 58% (15/26) patients were less than 2 years old and 58% (15/26) were male. The median age was 1.83 years [interquartile range (IQR): 1.88–5.75 years], ranging from 3 months to 15 years. All 26 (100%) patients were immunised. Significant medical comorbidities affected three children (12%): one patient had Saethre-Chotzen syndrome, one was on home oxygen due to chronic lung disease of immaturity, and one child had previously experienced a Bell’s palsy (completely resolved prior to onset of AOM).

Facial nerve function

All patients had a unilateral FNP: 38% [10] were affected on the right side and 62% [16] on the left. The median HB grade at presentation was 3 (IQR: 3–4) and one patient had a complete palsy (HB 6). Of children younger than two, severity of FNP was evenly distributed; 53% (n=8/15) had FNP with eye closure (HB 2–3), and 47% (n=7/15) had more severe FNP and were unable to close their eyes (HB grade 4–6). In older children over 2 years, milder HB 2–3 palsies were more common (n=8/11, 73%), while more severe HB 4–6 palsies were infrequent (n=3/11, 27%), however this difference was not statistically significant (Hodges-Lehmann estimator 0, 95% CI: 0 to 1, Mann-Whitney U test, P=0.30) (Figure 3).

Figure 3 Severity of facial nerve palsy at presentation comparing under 2-year-olds and over 2-year-olds.

Clinical presentation

This cohort of patients presented with the common clinical signs of AOM: 81% reported a preceding viral prodrome (n=21) and 53% of patients had fever (n=14). Patients were unwell prior to developing a FNP for 4.5 days (IQR: 1.75–7 days). A history of recurrent AOM was uncommon (12%, n=3). Three patients (12%) presented with concurrent ipsilateral perforated tympanic membrane.

At the time of grommet insertion, 25 patients had pus or thick middle ear fluid present (96%) and one patient had no fluid found in the middle ear. Two patients (8%) had bilateral AOM confirmed with pus present in both ears at the time of myringotomy, although both patients only had unilateral FNP.

Investigations

Imaging was performed for 12 patients (46%). Five patients had MRI scans (19%), four patients had a CT (15%), and three patients had both MRI and CT scans (12%). Seven patients were imaged at the time of admission (27%), and five patients had imaging following discharge as part of their clinical follow-up (19%). Two patients (16%) of the 12 patients who were imaged had a radiologically detectable dehiscence of the facial nerve canal on imaging.

Of the 25 patients who had swabs taken of middle ear fluid, 32% (8/25) had a clinically relevant pathogen identified (Table 3). A single patient was found to have multiple organisms at culture: Streptococcus pyogenes and Staphylococcus aureus. All identified bacterial species were sensitive to prescribed antibiotics, except for one patient who grew multi-resistant Staphylococcus aureus.

Treatment

All patients in our cohort were admitted to hospital and received antibiotics and steroids. All underwent myringotomy and at least ipsilateral grommet insertion. All were discharged with ear drops and a course of oral antibiotics.

Medical treatment

53% of the cohort (n=14) had a history of antibiotic treatment prior to hospitalisation for the same episode of AOM. 60% of patients under 2 years (n=9/15) had not taken antibiotics prior to admission to hospital, compared to 27% patients over 2 years old (n=3/11).

During admission at QCH, 96% of patients were treated with broad spectrum intravenous antibiotics (n=25). Local prescribing guidelines recommend oral amoxicillin for AOM and intravenous cefotaxime for mastoiditis (12). Currently there are no formal guidelines to recommend treatment for other complications of AOM outside of mastoiditis. Intravenous antibiotics used to treat our cohort were: cefotaxime/ceftriaxone (n=16, 62%), piperacillin-tazobactam (n=2, 8%), amoxicillin-clavulanic acid (n=5, 19%), lincomycin (n=2, 8%), benzylpenicillin/ampicillin (n=2, 8%), flucloxacillin (n=1, 4%), metronidazole (n=1, 4%), vancomycin (n=1, 4%), and ciprofloxacin (n=1, 4%). Five patients (19%) were treated with more than one antibiotic simultaneously.

At discharge, 96% of patients were sent home with oral antibiotics (n=25) for a 7–10 days duration. Amoxicillin-clavulanic acid was the most common agent (n=19, 73%). Topical ear drops were prescribed for 100% of patients, and the preparations used were: ciprofloxacin (n=16, 62%) and ciprofloxacin-hydrocortisone (n=10, 38%).

Steroids were prescribed in some form for all patients in the cohort. Steroid treatment initiated at admission was either intravenous dexamethasone (n=21, 81%) or oral prednisolone (n=5, 19%). The median duration of steroid treatment was 9.5 days (IQR 5–14 days). Ten patients (38%) were discharged with weaning prednisolone courses, nine patients (35%) were discharged with a short course of prednisolone not requiring a weaning plan, two patients received oral dexamethasone on discharge, and five patients (19%) received no further steroids after discharge. No complications arising from medical treatment were identified during review of the cohort.

Surgical treatment

Bilateral grommets were placed for 17 children (65%), while nine children had an ipsilateral grommet inserted on the side of the FNP (35%). No patients underwent mastoidectomy or facial nerve decompression surgery in this cohort, and no patients required reconstructive surgery. Two complications (8%) of surgical treatment were identified: one patient required removal of grommets due to persistent granulation tissue 2 years post insertion, and another patient required re-insertion of grommets due to early extrusion.

Facial nerve recovery

96% of children (n=25) in our cohort had complete recovery of facial nerve function (HB 1) confirmed by face-to-face examination. The cohort were followed up for a median of 402 days (IQR: 234–691 days) with a range of 21 to 1,614 days. No patients had recurrence of FNP during their observed follow up period and were not re-referred to QCH following discharge from clinic with recurrence of FNP. A single patient with an initial HB 3 palsy was lost to follow up. As there was no follow up examination, it is unclear if their facial nerve function changed; no signs of recovery were observed during their admission.

The median time to first sign of facial nerve recovery was 12 days (IQR: 5.5–28 days) with a range of 1–89 days (Figure 4). In Figure 4, five patients have only a resolution marker plotted (patients 2,3,14,18 and 24). No marker for first sign of recovery is included in the figure as there was no examination between discharge with FNP present and review where complete FNP resolution was confirmed. Children >2 years of age showed initial signs of recovery sooner [median 7.5 days (IQR: 3.75–12 days)] than children <2 years of age [median 18 (IQR 10–41)]. The median difference Hodges-Lehmann estimator was 14 days (95% CI: 3 to 28 days; Mann-Whitney U test, P=0.01). No association was found between severity of FNP and time to first sign of facial nerve recovery (Hodges-Lehmann estimator 0, 95% CI: −11 to 12 days, Mann-Whitney U test, P=0.99).

Figure 4 For each patient where follow up was recorded, time to first sign of recovery (circle) and time to resolution (triangle) for each patient is shown. House-Brackmann status at presentation is highlighted by specific colour as per legend. Patients 2, 3, 14, 18 and 24 have a single resolution symbol, as the first documented sign of recovery also showed complete resolution of the facial nerve palsy.

The median time to FNP resolution was 41 days (IQR: 24.5–98 days) with a range of 10–166 days (Figure 4). A trend towards a difference in time to complete recovery was identified based on severity of FNP (Hodges-Lehmann median difference −19 days, 95% CI: −88 to 1 days, Mann-Whitney U test, P=0.052) (Figure 5). No other factors were found to be associated with time to complete recovery including age (<2 or >2 years), gender, duration of intravenous or oral antibiotic course, topical medications, ipsilateral grommet alone vs. bilateral grommets, middle ear findings, and antibiotic treatment before presentation.

Figure 5 Time to complete facial nerve function recovery based on severity of facial nerve palsy comparing grouped House-Brackmann Status (2–3 and 4–6) which were median 30 days (18, 74 days), and median 60 days (34.5, 120.3 days) respectively did not show statistical significance between the two groups, Mann-Whitney test performed with statistical significance of P<0.05. H-B, House-Brackmann Status.

Systematic review of literature

Data reviewed 84 children <18 years of age from nine studies to investigate outcomes for FNP in AOM, as described in Table 4. The included studies were small retrospective series with heterogeneous patient populations, treatment protocols, outcome definitions and follow-up duration, limiting direct comparison and preventing formal meta-analysis. Given heterogeneity of data collected in the systematic review, IQR, and standard deviations were unable to be provided. The percentages reported are based on the data that was able to be obtained from each paper, therefore the denominators are variable. Overall methodological quality was moderate. Most studies clearly defined inclusion criteria included all patients within that time frame, and demographic data as well as clinical information was well-reported. However, confounding factors were rarely addressed and most had incomplete follow-up reporting. Detailed appraisal results are presented in Table 5.

Patients had a median age of 5.1 years with a range of 0.7 to 14 years old. They had a median initial HB grade of 3.5 (Figure 6). 100% (77/77) of children received medical treatment with antibiotics intravenously, orally or drops topically. Where specified, studies used cephalosporins, amoxicillin or amoxicillin with clavulanic acid as the intravenous or oral antibiotic of choice, and typically ciprofloxacin-hydrocortisone ear drops. However, there was variation of reported antibiotic administration route between studies; intravenous antibiotics were most commonly used. Three of nine studies did not specify the route of antibiotic administration (Table 4). Five of the nine studies discussed steroid treatment, and within these studies 55% (n=23/42) of children received oral or intravenous steroids.

Figure 6 HB status at presentation (median values provided, mean provided when median values were unable to be calculated) for each study in the systematic review. HB, House-Brackmann.

Surgery was performed for most children. 92% (n=71/77) underwent myringotomy and 68% (n=52/77) of patients had concurrent grommet insertion. A further 12% (n=9/77) of patients underwent mastoidectomy. A single patient had mastoidectomy without a myringotomy reported. Three children (4%) underwent facial nerve decompression surgery. The outcome of FNP for two of these patients were not specifically reported. The final child who underwent facial nerve decompression improved facial nerve function from a HB 6 to HB 5; this was the only child not to have a myringotomy at the time of mastoidectomy.

The 80% (n=56/70) of children with FNP due to AOM completely recovered facial nerve function, and the mean time to recovery was 63.5 days.

Discussion

This 10-year series is the largest observational study reporting outcomes of paediatric patients with FNP due to AOM to date. We observed 96% (n=25) of patients to return to normal facial nerve function after a median 41 days (range 10–166), with clinically meaningful improvement usually seen within the first 2 weeks. These results are in keeping with previously published literature. A key statistically significant finding from this study is that older children showed initial signs of recovery earlier than younger children. This may be due to older children having larger anatomical structures, therefore swelling is less likely to damage structures, and as swelling improves, structures can heal faster. It may also be due to easy identification of subtle changes of facial nerve function in older children rather than younger children. For ear, nose and throat (ENT) surgeons, these results support a pragmatic, standardised approach centred on prompt myringotomy with grommet insertion in conjunction with broad-spectrum antibiotics, topical therapy, and steroids. Our experience also provides evidence towards avoiding mastoidectomy or facial nerve decompression in the setting of uncomplicated AOM with no evidence of mastoiditis or alternative ear pathology. This study improves clinicians’ knowledge regarding the natural history of FNP due to AOM, enabling confident family counselling around prognosis of FNP, and reducing unnecessary invasive intervention in a rare, but often high-anxiety presentation.

Demographics

Our study identified younger patients (<2 years) were more likely to present with FNP due to AOM, in keeping with previous studies (6,9). This age group is more pathogen-naïve and has a developing immune system, making infections such as AOM and their complications more frequent (6,9,13-15).

Our study identified a median delay of 4.5 days (range of 1–11 days) between onset of AOM and onset of FNP, which is consistent with other studies (7,16,17). No association was identified between severity of FNP and duration of illness before FNP, which suggests that the timing of facial weakness onset is not a reliable predictor of disease severity and should not be used to guide escalation of management (7,8,13,17,18). Rather, the development of FNP at any point should prompt timely ENT assessment and management.

Clinical findings

A median HB grade of 3 in our cohort was similar to previous studies and severe or total palsy was uncommon as other groups have also reported (7,9,13,17,19).

Similar to Evans et al. [2005], only one of our patient cohort did not have an effusion, and the rest of the patients presented with either frank pus or thick middle ear effusion (20). The majority of patients presenting with an effusion would suggest early middle ear drainage as a key component of managing FNP in AOM. Three patients in this study had a perforation at the time of presentation, however these patients tended to have a more severe palsy, between HB 3–6 at the time of presentation. Although uncommon, the co-occurrence of tympanic membrane perforation with FNP may serve as a bedside marker for more severe initial dysfunction, supporting closer follow-up and monitoring in this subgroup. This observation is however based on small numbers and warrants further investigation.

No correlation was seen between imaging findings and recovery time, or severity of FNP. Given this low diagnostic yield in our cohort, in neurologically otherwise well children with uncomplicated AOM-associated FNP, routine imaging prior to grommet insertion may not be necessary unless symptoms are atypical, recurrent, progressive, or non-resolving palsies. Lorch and Teach [2010] support this, suggesting that imaging for FNP outside of a trauma setting should predominantly be done for atypical palsies lasting greater than 2 months, or for recurrent or progressive palsies (21).

As seen in previous studies, the most common culture result was no growth or mixed/normal skin flora, which is likely due to antibiotic use prior to sampling (7,22,23). The most common pathogens seen in complicated AOM were identified (8,9,16,23,24). Due to a lack of positive cultures throughout the literature, it is very difficult to recommend culture directed treatment for AOM with FNP. Rather, when establishing management guidelines, treatment needs to be empiric, highlighting the value of timely surgical drainage and broad-spectrum antimicrobial coverage, rather than reliance on culture-directed therapy alone.

Treatment

Previous studies have shown that most patients had taken prior antibiotic treatment, whereas in our study just over half had commenced antibiotic treatment prior to presentation, and most under 2-year-olds having not had any prior antibiotic treatment (17,22,25). This is likely due to current Australian guidelines which advise antibiotic prescription only for patients with complicated AOM, and that younger children are more likely to present to hospital with complicated AOM rather than a General Practice setting. Additionally, specifically to this study, QCH as a quaternary centre services a vast geographical area where many patients do not have access to primary healthcare, so presentation initially to a hospital with complications is more common.

As alluded to previously, there is no treatment consensus for FNP due to AOM (2,5). Myringotomy with grommet insertion was performed in all patients, as it is theorised to relieve facial nerve inflammation and pressure by enabling drainage of middle-ear exudate and facilitating topical therapy delivery within the middle-ear cleft (4,9,21,26,27). The use of broad-spectrum intravenous antibiotics with good meningeal penetration is widely supported in the literature rather than relying on a culture-directed approach as achieving positive cultures from middle ear fluid is difficult (1,5,6,8,9). All our patients received steroids in some form. Although many studies suggest that steroids hasten time to recovery and should be commenced within 7 days of symptom onset (2,10,28,29), other studies found the use of steroids to be controversial (4,13,22). While recovery outcomes were generally favourable, we continue to favour the use of steroids in this clinical setting based on biological plausibility and existing clinical practice. However, this study was unable to demonstrate an independent association between steroid use and facial nerve recovery, given the concurrent use of myringotomy and antibiotics.

In our cohort, no patient required escalation to mastoidectomy or facial nerve decompression. This is in keeping with multiple published series on cases of AOM-associated FNP case series in the absence of mastoiditis or other otologic pathology (22,26,30). While mastoidectomy has been proposed in selected cases where there is persistent otorrhoea and no improvement in facial nerve function (9), our findings support a more conservative treatment pathway. We would therefore recommend initial management with prompt grommet insertion and maximal medical therapy, reserving mastoidectomy for children with clinical or radiological evidence of mastoiditis.

Outcomes

Our recovery outcomes closely mirror the broader published experience and provide practical reassurance for clinicians. In our cohort the mean time to facial nerve recovery was 59.2 days, closely matching the recovery time of the systematic review (63.5 days), with 96% of children returning to a HB 1 baseline (1,4,7,9,17,19,20,30,31). Across the literature, findings differed as to whether initial palsy severity predicts timing of recovery (7,18,29,32,33). Our findings however suggest that while more severe palsy trended toward longer overall recovery, the time to first improvement did not differ by severity, indicating early clinical progress can still be expected even in higher HB grades. More reassuringly, this improvement occurred without an escalation in surgical intervention to mastoidectomy, reinforcing that initial management guidelines should focus on middle ear drainage and maximal medical therapy. Given that all patients in our cohort recovered to HB 1, we were unable to identify reliable predictors of poor outcome within our study population.

Our study had a generally younger cohort compared with the systematic review (5.1 years old compared with 1.8 years old), however had similar median HB status at initial presentation (3.5 and 3). While antibiotics and myringotomies +/− grommets were ubiquitously used in both cohorts, steroids were not used as commonly in the literature (55% compared with 100%). Although a similar time to recovery was seen between the two cohorts, 80% of patients recovered in the systematic review, compared with 96% in our study. Unfortunately, due to the substantial heterogeneity observed across included studies, compounded by generally moderate methodological quality on JBI appraisal, the conclusions that can be drawn are limited. Our retrospective series, while subject to its own limitations as discussed below, contributes a consecutive, single-institution cohort with standardised outcome assessment, offering a more internally consistent comparison point.

Strengths and limitations

The strengths of the study include data was captured over a long-time frame, and a large cohort was identified for an uncommon complication.

Our study was limited by lack of standardised follow up timing across the cohort of patients. As a result, the reported FNP recovery timing is taken from clinical notes made at arbitrary review appointments where timeframes varied between patients. This may falsely increase the reported time to improvement and to recovery of FNP. Documentation of palsy severity varied between documenting clinicians, sometimes requiring the authors to assign an HB grade at a particular timepoint based on clinical description. Assessment of FNP in children is often challenging due to limited cooperation for clinical examination, especially in the under 2-year-old age group, adding to subjectivity and some variability when reporting HB grading. Additionally, while the HB scale is universally used to assess FNP and found to have excellent inter-observer reliability, it has limitations (11). The HB scale has reduced sensitivity for detecting subtle gradations of recovery. It is a single global score to describe all the facial function including forehead, eyes, nasolabial area and mouth. In this study, eye closure was used as the critical feature to suggest severity, however a grade for facial nerve function for each facial subunit was not reported separately which may have provided higher sensitivity for detecting subtle recovery.

Children managed non-operatively were not identified in this study, introducing selection bias towards surgically treated children, and therefore conclusions cannot be drawn about the success of conservative management alone for AOM with FNP. Given this was a retrospective study, there was lack of comparator groups to assess if this condition can be managed conservatively. Additionally, as most patients in our study group underwent all treatment options available: antibiotics, surgery, and steroids; there was an inability to determine independent treatment effects. No further conclusions about individual treatment effects were also able to be made from the systematic review studies due to the heterogeneity of the results presented.

Finally, the observational nature of this retrospective study limits associations that can be drawn and exploration of causal-effect relationships. The nature of FNP as an alarming complication of AOM for families means that any prospective study poses ethical consideration in design, and the rarity of the pathology means the likelihood of achieving meaningful outcomes from a prospective study is low.

Future studies aiming to assess the role of steroids in the management of FNP for patients with AOM and assessing the significance of tympanic membrane perforations at presentation would clarify areas of interest identified in our cohort.

Conclusions

This study demonstrates favourable recovery outcomes among children with FNP secondary to AOM managed with myringotomy, antibiotics and steroids. Nearly all patients achieved complete recovery, typically within 2 months of onset. While no patients in this cohort required mastoidectomy or facial nerve decompression, the retrospective observational design limits conclusions regarding the independent therapeutic contribution of individual interventions. Further multicentre collaborative studies may help clarify optimal management strategies, particularly the role of steroids.

Acknowledgments

A complete literature search was completed by Louisa D’Arrietta (15/9/2025) at the Townsville University Hospital Library in Queensland, Australia.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://www.theajo.com/article/view/10.21037/ajo-2025-1-80/rc

Data Sharing Statement: Available at https://www.theajo.com/article/view/10.21037/ajo-2025-1-80/dss

Peer Review File: Available at https://www.theajo.com/article/view/10.21037/ajo-2025-1-80/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://www.theajo.com/article/view/10.21037/ajo-2025-1-80/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee as a Quality Assurance project exempt from ethical review (HREC: EX/2025/QCHQ/120401), and individual consent for this retrospective analysis was waived.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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