A 17-month-old girl presents to the pediatric emergency department for evaluation of right-sided facial palsy and decreased movement of her right arm. One week before presentation she was evaluated for acute onset of left eye redness, left-sided facial swelling, and a low-grade fever for 1 day. Her left tympanic membrane was described as dusky and slightly erythematous. Early acute otitis media was diagnosed, and amoxicillin therapy was started. Two days later her primary care physician evaluated her for persistent facial swelling despite antibiotic therapy. Her tympanic membranes appeared normal then and her neurologic examination was significant for facial nerve palsy with inability to close the right eye, incomplete raising of the right eyebrow, and drooping of the right side of the mouth. She was diagnosed as having Bell’s palsy. Amoxicillin was discontinued, and acyclovir (20 mg/kg 3 times daily) and prednisolone (1 mg/kg once daily) were started.

The parents now...

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