Facial nerve palsy secondary to middle-ear lipoma.

OBJECTIVE: We present the first reported case of a middle-ear lipoma presenting with facial nerve palsy. We review the available literature on middle-ear lipomas and alert the surgeon to the possibility of a lipoma occurring in this location.

CASE REPORT: A 33-year-old man presented to our unit with a right-sided, House-Brackmann grade two, lower motor neurone facial palsy. A computed tomography scan revealed abnormal soft tissue in the epitympanic recess, extending to the region of the geniculate ganglion. At middle-ear exploration, a lump of fatty tissue was found filling the anterior middle-ear cleft, juxtaposed to the horizontal portion of the facial nerve. The patient's facial palsy resolved within a few weeks of surgery.

CONCLUSION: Lipomas are a rare but real differential diagnosis of a mass in the middle ear. Early imaging is advised.