OBJECTIIVE: To highlight the significance of acute otitis media (AOM) as the etiology of peripheral facial palsy (PFP) in children.
CASE REPORT: A 12-year-old female presented with a sudden asymmetry on her left-side face 12 hours prior. She started to dribble water through her left lips while drinking followed by the inability to close her left eye properly. Five days prior she had fever, cough, coryza and sore throat, but only the latter remained. She was also complaining about pain and fullness in the left ear since 2 days. She appeared with fever and a Grade IV House-Brackmann left facial palsy. Otoscopic examination showed inflammation of  tympanic membrane with the presence of pus. Inflamation of oropharynx and the tonsils were also found with Modified Centor score of 4. She was diagnosed with left hemifacial palsy caused by left AOM with suspected streptococcal pharyngotonsillitis. She was treated with oral steroid and antimicrobial agent. She began to show improvements after two weeks of treatment initiation and recovered completely after four weeks. 
DISCUSSION: Infection is still the most common identified etiology of PFP in children. Around 9.6-46.8% of pediatric PFP cases is caused by infection and AOM constitutes around half of infectious cause of PFP. It is causing around 4.0-31.4% of PFP cases in children. Around 78% of facial palsy occured in the first three days of AOM presentation while the rest occured at fourth to ninth days. An excellent recovery from AOM-related facial paralysis in children has been documented, but few has reported an incomplete recovery even with proper treatment.
CONCLUSION: AOM as the most common cause of infection-related PFP in children should be considered in every PFP cases. Thorough evaluation of the ears is needed for early recognition, thus would prevent future sequelae.