A Quarter Horse gelding presented to Cornell University's Equine and Nemo Fann Animal Hospital Emergency Service for a I week history of cranial nerve VII paralysis, intermittent fever, and discharge from the right ear. Otitis media was presumptively diagnosed by the referring veterinarian. Culture of the aural discharge resulted in mixed bacterial growth, primarily Escherichia coli. He was treated with flunixin meglumine and trimethoprim sulfa without improvement. On presentation, the patient was admitted into an isolation stall and was bright, alert, and responsive. Physical examination abnormalities were: right cranial nerve VII paralysis, moderate amount of discharge from the right ear that was sensitive to the touch, trace amounts of bilateral white nasal discharge, and subtle right-sided head tilt. Endoscopic evaluation revealed many abnormalities of his right guttural pouch, including a hyperemic, proximally inflamed temporohyoid bone mucosa, and a moderate amount of mucopurulent discharge. The right guttural pouch was sampled and flushed, to confirm a presumptive Streptococcus equi subsp. equi infection. The patient was started on penicillin G potassium and continued to receive flunixin meglumine, omeprazole, and lubrication for his right eye due to insufficient blink. Polymerase chain reaction (PCR) and culture of the guttural pouch debris confirmed an infection of Streptococcus equi subsp. equi. During hospitalization the guttural pouches were repeatedly flushed with saline and treated with penicillin-dihydrostreptomycin in oil. The facial nerve paralysis and otitis media resolved. The guttural pouches normalized and were PCR and culture negative for Streptococcus equi subsp. equi on day 17.