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Tick induced facial nerve paresis

: We present a literature review examining the research surrounding tick paralysis resulting in facial nerve palsy. A novel case of an intra-aural paralysis tick bite resulting in unilateral facial nerve palsy is also discussed. A review of the literature was conducted using MEDLINE and EMBASE databases for relevant literature published between 1915 and 2020. Utilising the following key words: “Ixodes”, “Facial paralysis”, “Tick bite”, and “Australia”. Eighteen articles included in the review comprised a total of 48 patients. Patients’ ages ranged from 1 to 84 years of age. Ten studies estimated the possible duration between tick bite and facial nerve palsy, averaging 8.9 days. Forty-one patients presented with a single tick within the external auditory canal (EAC), three had a single tick located on the temple or forehead region, three had post-auricular ticks and one patient had a remarkable 44 ticks removed from the face, scalp, neck, back and limbs. A complete ipsilateral facial nerve palsy was present in 45 patients, notably in 16 patients this occurred following tick removal. House-Brackmann classification was utilised in 7 patients; 4 patients with grade 4, 1 patient with grade 3, and 2 patients with grade 2 facial nerve palsy. Thirty-eight patients had complete recovery of facial palsy. Thirteen studies were analysed for time to recovery, with an average time of 19 days. Six patients had partial recovery at time of follow up. One patient died from respiratory arrest following generalized paralysis. Tick paralysis is a severe, but preventable disease. Careful examination of the face, scalp and EAC should be conducted in patients presenting with otalgia and facial nerve palsy, particularly in tropical areas, to exclude the possibility of tick infestation.