Transient Unilateral Facial Nerve Baroparesis with Vertigo on Ascent in the F-16CM.

BACKGROUND: Presented is a rare case of transient unilateral facial nerve paralysis occurring in a pilot while on initial ascent in an F-16CM. This pathology is sporadically observed in the diving community, but rarely described in military or civil aviation. This case was particularly unusual in its promptness of onset, rapid recovery, and its association with vertigo. CASE REPORT: This case report describes a previously healthy 26-yr-old F-16 pilot who experienced ear block and subsequent unilateral facial paralysis while on initial ascent. This was relieved quickly after clearing the affected ear without any neurological sequelae. A second episode was associated with vertigo in addition to the ear block and facial symptoms. Both episodes were separated by 3 d. DISCUSSION: Barotrauma to the facial nerve via an uncovered or "dehiscent" facial nerve canal was suggested by the clinical course, computed tomography, and confirmed by expert consultation. Making the diagnosis in an aviator, especially the military aviator, is important for safety of flight, to avoid unwarranted diagnostics, and to minimize operational impact. A mechanism for the aviator's associated vertigo is suggested.