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ENT · Ear and audiology: facial nerve schwannoma
Sample itemA 35-year-old man has facial weakness that progressed over eight months with no recovery, after earlier twitching. Otoscopy is normal. CT shows smooth enlargement of the geniculate ganglion region of the facial canal. What is the most likely diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. Facial nerve schwannoma
Facial palsy that is slowly progressive, does not recover within about four months, or follows twitching should raise suspicion of a facial nerve tumour. CT shows smooth expansion of the fallopian canal, commonly around the geniculate ganglion. Bell palsy usually begins abruptly and improves.
Option by option
A. Facial nerve schwannoma (correct)
Correct. Slow progression without recovery and smooth canal expansion indicate a facial nerve schwannoma.
B. Bell palsy
Bell palsy has an abrupt onset with recovery in most patients, and imaging is normal.
C. Malignant otitis externa
Malignant otitis externa is a painful diabetic infection with otorrhoea and granulations, with canal erosion rather than smooth expansion.
D. Ramsay Hunt syndrome
Ramsay Hunt syndrome has painful vesicles and a rapid onset.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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