Acute otitis media is diagnosed commonly in the pediatric population. Numerous complications, one of which is facial palsy, may result. Facial paralysis may be the initial complaint in the child in whom acute otitis media later develops on the affected side, as was true in the case reported here. Dehiscence of the fallopian canal, physiologic canaliculi along the facial nerve to the periphery, and host resistance play an integral part in the development of facial nerve palsy from acute otitis media. The two most effective neurodiagnostic studies are the nerve excitability test and electromyography. The author also recommends daily acoustic reflex testing for denervation or reinnervation. Specific indications for conservative therapy (myringotomy, antibiotic, and decongestant) as well as for surgical intervention are discussed. The treatment in the present case was particularly conservative. It included only a broad-spectrum antibiotic, with good results.