Extreme fatigue, pallor, ear drainage after Bells Palsy diagnosis

My husband was diagnosed with Bell's Palsy about 2 weeks ago, after an episode of intense ear pain that was initially diagnosed and treated as a severe ear infection.  His doctor said his ear canal was so swollen, she couldn't even get the otoscope in his ear.

He has completed his antibiotics for what was presumed to be the ear infection, and has also completed his antivirals and prednisone for the Bells Palsy which developed 3 days later.   He had a CT scan in the ER when his symptoms began, which was reportedly negative.
He is slowly improving, so far as the severe pain, the inability to close his eye, and the droopy mouth is concerned.

The problem now is that he is becoming extremely fatigued every day.  He starts out the day relatively well, but by the time he comes home at 3 or 4 pm, he is extremely pale and exhausted.  Its all he can do to simply fall on the couch and sleep.  He is unable to do anything that he enjoys doing.  This is absolutely contrary to his normal behavior.

Another odd symptom is that last night, the ear in which he had the original pain has begun draining clear fluid in fairly copious amounts.  He continues to complain of mild pain in this ear.   The fluid looks clear, but has an odd, almost "menthol" smell to it.  No blood or pus.  He is not using any product of any kind in the ear.

He has no vertigo at all.  No loss of taste or smell.  

Are these symptoms (the pallor, extreme fatigue/lethargy, and ear draining) something to be expected when recovering?  There is a question if this is Bells palsy or Ramsey-Hunt, but as the treatment seems to be the same, no one is significantly trying to determine which he has.

Thank you.

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

Extreme fatigue is not a typical feature of classic Bell's palsy. In addition, ear draining certainly is not a feature of Bell's palsy. Any type of ear draining with pain suggests a possible infection. Ramsay-Hunt is a disorder involving viral infection with the virus HSV; it would to my knowledge not cause purulent ear draining. A bacterial infection, or a collection within the inner ear (what is termed a choleasteatoma, which follows chronic ear infections) are one possibility. An obstruction in the ear of some sort, causing both ear draining and affecting the 7th cranial nerve is a possibility (the nerve affected in Bell's palsy). A regular CT scan may not adequately evaluate the ear area, and dedicated specific type of CT is sometimes indicated. MRI of the brain is more helpful in evaluating certain structures such as the 7th cranial nerve.

Evaluation by an ENT (ear nose throat) specialist is recommended, with followup with the neurologist as well.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[peekawho]

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