Therapeutic Management of Bilateral Partial Facial Nerve Paralysis due to Otitis Media in a Bullock.
Bilateral and partial facial nerve paralysis in a bullock was diagnosed with clinical signs of ptosis of upper eyelids, ear drooping and feed accumulation between cheeks and teeth. Ocular discharges were normal with moderate saliva drooling indicating non involvement of parasympathetic portion of facial nerve. Tongue movement was normal but prehension capacity was lost. The aetiology was attributed to chronic otitis media and extension of inflammation to facial nerve through eustachean tube. The case was successfully treated with Fluroquinolones, Flunixin and cortisones. It was concluded that partial bilateral paralysis of facial nerve due to otitis media could be treated successfully with corticosteroidal therapy.
Keywords: Bullock; facial nerve paralysis; otitis media
Facial nerve paralysis in cattle is one of the unusual conditions reported. As silage feeding is not a common practice in certain parts of India like Andhra Pradesh, incidence of facial nerve paralysis due to listerial infection is rare. Further, infections of external ear or middle ear are occasionally reported in buffaloes due to their wallowing habits and relatively uncommon in cattle. Hence, in the present paper, unusual case of facial nerve paralysis due to otitis media is presented.
History and Diagnosis
A bullock aged about ten years was brought with a complaint of off feed for a few days. It was treated earlier for primary ruminal dysfunction without any success. At the time of drinking water, the bullock was dipping its muzzle beyond the level of angle of mouth on either side. There was ptosis of upper eyelids bilaterally (Fig. 1). Both ears were drooping, carried at a lower level (Fig. 2) and sensation was also lost.
The animal lost its prehension ability and was going down in physical condition. When the animal attempts to take feed with difficulty, accumulation of feed was observed between lips and cheeks following grazing.The accumulated feed material could be taken out manually after opening the oral cavity. The movement of tongue was normal with drooling of saliva occasionally. The bullock was said to have been suffering from chronic otorrhoea in both ears for more than a year. Examination of external ear canals revealed moderate sticky discharges with significantly offensive smell. No mites were seen in both ears.The animal was occasionally showing shaky head movements. Based on the above clinical signs, it was diagnosed as facial nerve paralysis due to otitis media and was treated on medical grounds.
Treatment and Discussion
The external ear canal was cleaned daily with diluted Povidone iodine solution. Ear drops comprising Ciprofloxacin with Dexamethasone were instilled in to ear canal. Prednisolone acetate was administered @ 1 mg/kg IM for three consecutive days. Enrofloxacin @ 5 mg/kg b.wt. was given IM daily for a period of twenty days. Flunixin meglumine injection @ 2.2 mg/kg was given IM for four day i.e. after the last dose of cortisone. Vitamin [B.sub.1] [B.sub.6] and [B.sub.12] were injected @ 10 ml IM daily for a period of ten days. Hydroxy methyl cellulose eye drops were instilled into eye periodically to prevent corneal dryness. The unfavourable prognosis of the condition was explained to the owner.
Odriozola et al. (2009) observed eyelid ptosis, keratoconjunctivitis and different degrees of ataxia with morbidity and mortality rates ranging from 1.1 to 50% associated with paralysis of facial and vestibulo cochlear nerves due to intracranial space occupying lesions in feedlot cattle.
In cattle, facial nerve paralysis has been reported due to meningo-encephalitis caused by Listeria monocytogenes (Campero et al., 2002 and Schweitzer et al., 2006), neoplasia such as meningioma and acoustic neuromas, (Lamm et al. 2004), otitis media (Jensen et al., 1983) etc. As silage feeding and listerial infections are not common in Andhra Pradesh, listerial infections were ruled out. In our case, otitis media appeared to be the probable cause, as it is the common cause of facial nerve paralysis in all species (Maenhout et al., 1984). Otitis media is common in calves, generally with acute presentation especially during drought seasons (Maeda et al., 2003). This is also a frequent pathology found in feedlot cattle and commonly associated with affections of upper respiratory tract that progresses via Eustachian tube (Francoz et al., 2004).
Due to the fact that, inner ear is closely associated with cranial nerves VII (facial) and VIII (vestibulocochlear), presenting signs of inflammation to this area are the result of insult to these nerves.
Inflammation of middle ear will result in paralysis of affected side of face including ear droop, weakness of eyelid, and drooping of facial muscles (Schweitzer et al., 2006).
In our case, changes in eye like keratoconjunctivitis sicca or vertical nystagmus as seen in affections of vestibulocochlear nerve were not seen. This could be attributed to blindfolding or drooping of upper eyelid, which might have prevented corneal dryness. The palpebral fissures were decreased due to complete drooping of upper eyelids on either side and paralysis of frontalis muscle above the eyelids giving a relatively moderate pitting appearance at the forehead region (Fig. 3). But vision was intact when tested after raising the upper eyelid (Fig. 4).
The diagnosis based on clinical signs was relatively felt easier in present instance. Contrary to this, Maenhout et al. (1984) felt that, bilateral facial paralysis might be more difficult to recognize, but affected animals drooled and had dull facial expression.
A lesion of auriculopalpebral branch of facial nerve, near zygomatic arch results in paresis or paralysis of eyelids and ear only. A lesion of palpebral branch of facial nerve, crossing the zygomatic arch, results in paresis or paralysis of eyelids only (Maenhout et al., 1984). As paralysis in present case was bilateral, lesions involving individual nerve trunks could not be thought of.
The clinical signs involving nostrils like inspiratory dyspnoea were not observed in present case. The muscles of lips appear to have paralysed as there was accumulation of feed and fluids when animal eats or drinks. There was only partial drooling of saliva and normal ocular discharges which could be attributed to non involvement of parasympathetic portion of facial nerve and consequent decrease in production of saliva.
But in our case, symptoms started resolving with corticosteroid therapy for initial three days. The otorrhoea responded well to the medical treatment. Fluroquinolones like Enrofloxacin and Ciprofloxacin are effective against Mycoplasma and can penetrate in to the ear (Schweitzer et al., 2006). Flunixin meglumine is known to be beneficial in alleviating signs of cranial nerve pathologies.
Campero, C.M. (2008). Listeria monocytogenes en bovinos y ovinos y su rol como zoonosis, 257-266. In: Cacchione R.A., Durlach R. & Martino P. (Eds), Temas de Zoonosis. IV. Asociacion Argentina de Zoonosis, Buenos Aires.
Francoz, D., Fecteau, G., Desrochers. A. and Fortin M. (2004). Otitis media in dairy calves: A retrospective study of 15 cases (1987 to 2002). Can. Vet. J. 45: 661-66.
Jensen. R., Maki, L.R., Lauerman, L.H., Raths, W.R., Swift, B.L., Flack, D.E., Hoff, R.L., Hancock, H.A., Tucker, J.O., Horton, D.P. and Weibel, J.L. (1983). Cause and pathogenesis of middle ear infection in young feed lot cattle. J. Am. Vet. Med. Assoc. 182: 967-72.
Maeda, T., Shibahara, T., Kimura, K., Wada, Y., Sato, K., Imada, Y., Ishikawa, Y. and Kadota, K. (2003). Mycoplasma bovis-associated suppurative otitis media and pneumonia in bull calves. J. Comp. Pathol. 129:100-10.
Maenhout, D., Ducatelle, R., Crussement, W., Nuytten, J., Thoonen, J. and Hoorens, J. (1984). Space occupying lesions of cranial nerves in calves with facial nerve paralysis. Vet. Rec. 115: 407-10.
Odriozola, E., Diab, S., Khalloub, P., Bengolea, A., Lazaro, L., Caffarena, D., Perez, L., Canton, G. and Campero, C. (2009). Facial paralysis and vestibular syndrome in feedlot cattle in Argentina. Pesq. Vet. Bras. 29.
Schweitzer, G., Ehrensperger, F., Torgerson, P. R. and Braun, U. (2006). Clinical findings and treatment of 94 cattle presumptively diagnosed with listeriosis. Vet. Rec. 158: 588-92.
V. Devi Prasad (1), P. Ravi Kumar (2) and N.V.V. Harikrishna (2)
Department of Veterinary Surgery and Radiology NTR College of Veterinary Science Sri Venkateswara Veterinary University (SVVU) Gannavaram--521101 (Andhra Pradesh)
(1.) Associate Professor and Corresponding author. E-mail: firstname.lastname@example.org
(2.) Assistant Professor
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|Title Annotation:||Short Communication|
|Author:||Prasad, V. Devi; Kumar, P. Ravi; Harikrishna, N.V.V.|
|Date:||Jul 1, 2016|
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