The mother of this 3-year-old boy noticed that his smile was asymmetric when he awoke that morning. He had been seen 3 days previously for left ear discomfort, sore throat, and a low-grade fever.
The patient's temperature is 38°C (100.4°F). He appears nontoxic, and his responses are appropriate. His left tympanic membrane is inflamed, and the drum is bulging. A purulent discharge is noted in the left ear canal and surrounding area. The right tympanic membrane is also inflamed and bulging, but there is no discharge. A left facial droop is noted. The child is able to close his left eye and has partial eyebrow movement. His facial sensations are intact. In the left ear, he is unable to hear the examiner rubbing his fingers together. The remainder of the physical examination findings are unremarkable.
What is the most likely cause of the patient's facial palsy?
- Ramsay Hunt syndrome
- Bell palsy
- Otitis media
- Lyme disease