Table 2.

Characteristic signs of specific causes of facial palsy.

Signs	Possible Causes
History of trauma	Search for stigmata of temporal bone fractures: haemotympanum, traumatic perforation, Battle’s sign
Gradual onset	Malignancy
Tick bites or possible exposure	Lyme disease
Erythema migrans	Lyme disease
Arthritis	Lyme disease
Bilateral involvement	Lyme disease, polyneuropathy
Forehead sparing	Central nervous system cause
Abnormal otoscopy	Acute otitis media, cholesteatoma
Fever	Infectious cause (acute otitis media)
Vesicular rash or blistering of the face or ear canal	Ramsay Hunt syndrome, herpes zoster virus infection
Ear pain	Herpes zoster virus infection
Rest of the neurological examination abnormal	Malignancy
Examination of the neck: lymph nodes or mass	Malignancy
High blood pressure	Malignant hypertension