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32วารสาร หู คอ จมูก และ ใบหน้าปีที่ 10 ฉบับที่ 3 ก.ค. - ก.ย. 2552On examinations, the vital signs were T 38.3 o C , BP 110/70 mmHg, PR 96/min and PR 20/min. The left facial paresis was of lower motor neuron type with left Bell’s phenomenon. Gradingaccording to House-Brackman were III in the upper part and V in lower half. (Figure 1) Otoscopicfindings were edematous swelling of external ear canal, thickening and 30% perforation of the lefttympanic membrane (Figure 2). The middle ear mucosa seen through the perforation was also thickeningwith granulation tissue and yellowish debris. The left mastoid was mildly tender on palpation.The right ear was entirely normal. The tuning fork tests revealed a lateralization to the left for Weber’stest, negative left Rinne’s and positive right Rinne’s test. Pure tone audiogram showed a leftmixed hearing loss (AC = 95 dB, BC = 53 dB), with pure tone average (PTA) of 80 dB and speechdiscrimination score (SDS) of 40%. The right ear was normal.Figure 1 : Facial paresis on his left side.Figure 2 : Otologic finding of left external acoustic canal and tympanic membrane.