Intended for healthcare professionals

Endgames Case Review

A half tingling throat

BMJ 2022; 376 doi: (Published 24 February 2022) Cite this as: BMJ 2022;376:e067996
  1. Hui-Shan Tsai, family medicine consultant1,
  2. Kuang-Yu Niu, emergency medicine consultant 2
  1. 1Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
  2. 2Department of Emergency Medicine, Chang Gung Memorial Hospital Keelung Branch and Chang Gung University College of Medicine, Keelung, Taiwan
  1. Correspondence to: K-Y Niu peidra.niu{at}

A woman in her 70s presented to the emergency department with a four day history of left sided sore throat, hoarseness, facial weakness, ear pain, tinnitus, and dysphagia.

Examination showed left facial palsy (facial droop and loss of forehead movement) and vesicles in the swollen left auricle and external auditory canal (fig 1). Eye closure and taste were unaffected, and the tongue did not deviate. Muscle strength of the limbs was normal, with no dysmetria or ataxia. The patient had no meningeal signs, headache, or nausea, and vital signs and temperature were normal. Laryngoscopy revealed left palatal palsy, injected aryepiglottic fold with shallow ulcers (fig 2 …

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