A 40-year-old female presented with unilateral, lower motor neuron, facial nerve palsy preceded by a four day history of ipsilateral otalgia and pyrexia. CT scan revealed middle ear opacification without bony erosion or intracranial complication consistent with acute facial nerve palsy secondary to acute otitis media. Usual practice previously described in the literature involves intravenous antibiotics, steroids and urgent surgical intervention in the form of myringotomy and grommet insertion. Following initial treatment with intravenous antibiotics and steroids a rapid improvement of both otalgia and facial nerve palsy was observed rendering surgical intervention unnecessary. The patient was discharged 48 hours later without surgical intervention and made a full recovery.