The etiology of Bell's palsy: a review

Comparison of glucocorticoids combined with antiviral drugs versus glucocorticoids alone in the management of Bell's Palsy: A systematic review and meta-analysis of randomized clinical trials

OBJECTIVE

This study aimed to compare the efficacy of glucocorticoids combined with antiviral drugs (GA) versus glucocorticoids alone (GO) in the treatment of Bell's Palsy.

DATABASE REVIEWED

According to the PRISMA2020 guidelines, we searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for English articles from their inception to August 10, 2023, and performed a secondary search on October 31, 2024.

METHODS

Studies describing the efficacy of (GA) for Bell's Palsy versus (GO). Patient demographics, cure rates, and results of subgroup analysis were collected. Stata 17.0 was used to perform the calculation and to draw relevant meta-analysis pictures. RevMan 5.4 was used to determine the source of bias and to summarize the risk of bias. Heterogeneity was assessed using Q-tests and I2 statistics.

RESULTS

A total of 10 RCTs enrolling 2893 participants were finally included in the meta-analysis. The treatment rate in the group of GA and the group of GO was 88.7 % and 83.2 %, respectively. The difference in the treatment rate between the two groups for Bell's Palsy was significant (relative risk (RR) = 1.09, 95 % confidence interval (CI) = 1.03-1.15), and significant heterogeneity was (I2 = 63.6 %, p = 0.003 < 0.1).

CONCLUSIONS

This review suggests that GA may be an effective treatment for Bell's palsy. Compared with GO, GA can improve the cure rate of Bell's palsy.

Sex differences in perceived speech intelligibility in patients with facial nerve palsy

PURPOSE

Facial nerve palsy (FNP) affects physical and social function, including speech. There exists discrepancy between professional and patient perception of appearance following FNP; however, speech differences remain unknown. We aimed to compare ratings of speech intelligibility by different listeners.

METHOD

Patients were identified through the Sydney Facial Nerve Service. FNP related scoring was obtained using the Sunnybrook Facial Grading System, Sydney Facial Grading Score, Facial Disability Index, and Speech Handicap Index. Intelligibility was scored by a speech-language pathologist, member of the public, and patient using a standardised passage. FNP scoring and intelligibility were compared using interclass coefficients (ICC).

RESULT

Forty patients were recruited (females = 20). There was no difference in FNP scoring, nor between the frequency or types of phonemic errors. Observers' rating of intelligibility had an ICC of 0.807, compared with 0.266 and 0.344 for patients compared to the member of the public and speech-language pathologist respectively. Observers rated males and females intelligibility similar (p > 0.05), but females rated their intelligibility lower than males (74.5 ± 12.8 vs. 82.5 ± 8.4, p = 0.025).

CONCLUSION

Patients, particularly females, perceive their speech to be less intelligible than observers. Clinicians should be aware of this discrepancy, which does not correlate with physical function.

Recurrent Bell's Palsy: A Comprehensive Analysis of Associated Factors and Outcomes

Background: Bell's palsy is a common peripheral facial nerve disorder that manifests as sudden unilateral facial paralysis. The condition, believed to be caused by viral infections and ischemic processes, affects a significant portion of the population and is associated with various systemic comorbidities. This study aimed to analyze the clinical characteristics, risk factors, and prognosis in primary and recurrent Bell's palsy to identify factors associated with recurrence and outcomes. Methods: A retrospective study was conducted on patients diagnosed with Bell's palsy at tertiary hospital between 2018 and 2024. Data collected included demographic information, comorbid conditions, clinical features, and recovery outcomes. Statistical analyses were performed to determine the significance of various factors in the recurrence of Bell's palsy. Results: The study included 254 patients. Recurrence was observed in 20.9% of cases. Significant risk factors for recurrence included diabetes (33.3%), hypertension (41.0%), hypothyroidism (56.1%), autoimmune disorders (54.2%), and a family history of Bell's palsy (48.6%). The severity of initial paralysis also influenced recurrence rates. Complete recovery from the initial episode was achieved by 66.9% of patients, whereas prolonged recovery times were noted in recurrent cases. Conclusion: The study highlights the significant role of systemic comorbidities and the severity of initial presentation in the recurrence of Bell's palsy.

Study protocol for a randomized trial comparing two electroacupuncture waveforms for different severity groups of Bell palsy

Background

Bell palsy (BP) is the most common cause of acute peripheral facial palsy which leads to functional and esthetic disturbances in patients and has a negative influence on daily living. Electroacupuncture (EA) has been considered an alternative treatment for improving facial function in patients with BP. However, there is no agreement on the preferred waveform type of the EA for treating BP.

Methods

This is a study protocol for a pilot randomized, two-arm, three-center, clinical trial at the Third Affiliated hospital of Zhejiang Chinese Medical University, the First Affiliated hospital of Zhejiang Chinese Medical University, and the Hangzhou First People's Hospital. The trial began in November 2023 and is expected to end in December 2025. Sixty patients with BP whose electroneurography (ENoG) value is at least 20% and 60 patients with BP whose ENoG value is less than 20% will be randomly assigned to the low frequency continuous waveform group or the intermittent waveform group in a 1:1 ratio. Participants will receive 4 weeks of EA treatment and clinical assessments. The primary outcome is the change from baseline score of the Facial Nerve Grading System 2.0. The secondary outcomes include the change from baseline score of the Sunnybrook grading scale and the change from baseline amplitude of the compound muscle action potential of the affected side in the ENoG tests.

Discussion

This is the first study protocol to compare the treatment effect and safety of EA with low frequency continuous waveform and intermittent waveform for different severity groups of BP. This study will contribute to subsequent studies for exploring optimal EA parameters for BP treatment.

Clinical trial registration

ClinicalTrials.gov, NCT06063954.

Bell's palsy characteristics, clinical manifestations, complications, and prognosis in a primary care setting, a single center study: A retrospective cohort study

Background

Bell's palsy (BP) is a cranial nerve disorder in which unilateral or bilateral paralysis of the facial nerve occurs. The study aims to study BP's characteristics, including its clinical manifestations, prognosis, and complications among adult patients aged 18 years and above.

Methods

A retrospective study of adult patients diagnosed with BP in a primary care setting] [January 2015 to December 2022].

Results

The study included a total number of 92 patients with an incidence rate of 23 cases per 100,000 people. The mean age was 43.52 years. The most common symptoms reported were dropping of the mouth at 38.9%, loss of forehead muscle movement at 24.4%, loss of nasolabial fold at 22.2%, loss of facial expressions at 20%, and headache at 18.9%. Immunodeficiency affected 2.3% of the patients. The management of patients involved the use of steroids in 76.1% and the use of antiretroviral medications in 48.9%. Physiotherapy was used in 29.5%. The complete recovery rate during the first year was 90.8%. The rate of complete recovery within two years was 96.9%.

Conclusion

The incidence of BP in the region seems to be similar to the incidence rate reported elsewhere in the world. The use of antiviral therapy seems to be high despite the controversy around the use of antivirals in the management of BP. The majority of patients with BP recover within the first year.

Development of a clinical diagnostic model for Bell's palsy in patients with facial muscle weakness

Early diagnosis of Bell's palsy is crucial for effective patient management in primary care settings. This study aimed to develop a simplified diagnostic tool to enhance the accuracy of identifying Bell's palsy among patients with facial muscle weakness. Data from 240 patients were analyzed using seven potential clinical evaluation indicators. Two diagnostic benchmarks were established: one based on clinical assessment and the other incorporating magnetic resonance imaging (MRI) findings. A multivariate logistic regression model was developed based on these benchmarks, resulting in the construction of a predictive tool evaluated through latent class models. Both models retained four key clinical indicators: absence of forehead wrinkles, accumulation of food and saliva inside the mouth on the affected side, presence of vesicular rash in the ear or pharynx, and lack of pain or symptoms associated with tick exposure, rash, or joint pain. The first model demonstrated excellent discriminative ability (area under the curve [AUC] = 0.96, 95% confidence interval [CI] 0.94 - 0.99) and calibration (P < 0.001), while the second model also showed good performance (AUC = 0.88, 95% CI 0.83 - 0.92) and calibration (P = 0.005). Bootstrap validation indicated no significant overfitting. The latent class defined by the first model significantly aligned with the clinical diagnosis group, while the second model showed lower consistency.

Acute Onset of Peripheral Facial Nerve Palsy in Children: An Overview

Background The facial nerve (FN) plays a pivotal role in human life; apart from its sensory and parasympathetic functions, it innervates the facial muscles, and it is therefore involved in non-verbal communication, allowing us to express emotions and reactions. Especially in the case of childhood onset, FN dysfunction can severely affect the quality of life. Methods The aim of this review is to analyze the most recent literature, focusing on the acute onset of peripheral FN palsy among pediatric patients, discussing the different etiologies, prognoses, and management strategies. A total of 882 papers were initially identified, but only 7 met the selection criteria. Therefore, data on 974 children in total were pooled and analyzed. Results According to the findings of this review, FN palsy is idiopathic in most cases, while an infective etiology was identified as the second most common. The main pathogen agents identified were Borrelia Burgdorferi, especially in endemic areas, and Herpesviridae. Respiratory tract infections and/or ear infections were also described. Head trauma or direct injury of the FN accounted for 2% of all cases. Conclusions The overall FN recovery rate is high, even though the etiology remains unknown for most patients. Therapeutic indications are still lacking, especially in the case of non-recovering FN palsy. In our opinion, large, prospective studies are necessary for improving our knowledge of this disorder and establishing evidence-based approaches.

Facial nerve decompression of a PICA vessel loop: A case report

INTRODUCTION AND IMPORTANCE

Facial nerve palsy is a common condition with various etiologies. However, compression due to a vessel loop is an exceptionally rare cause. This case report highlights the unusual presentation and management of facial nerve palsy caused by vascular compression, emphasizing the importance of considering rare etiologies in persistent cases.

CASE PRESENTATION

We describe the case of a young female patient who presented with a history of right blepharospasm and facial muscle twitching for several years. Cranial magnetic resonance imaging (MRI) revealed a posterior inferior cerebellar artery (PICA) vessel loop compressing the exit of the acoustofacial bundle at the level of the brainstem.

CLINICAL DISCUSSION

The patient's condition necessitated a microscopic surgical decompression to relieve the compression on the facial nerve. During the procedure, the facial nerve was freed and cushioned using Teflon. This intervention highlights the potential for surgical resolution in cases of facial nerve palsy caused by vascular compression, despite its rarity.

CONCLUSION

Postoperatively, the patient was free from blepharospasm and showed significant clinical improvement in facial muscle control. This case underscores the importance of considering vascular compression in the differential diagnosis of persistent facial nerve palsy and demonstrates the efficacy of surgical decompression in such cases.

Elevated TRPV2 expression in the facial nerve of rats by cold stimulation: Implications for Bell's palsy

OBJECTIVE

Bell's palsy, also referred to as clinical manifestations of unilateral facial nerve palsy, encompasses downward angling of the corners of the mouth, the absence of forehead creases, and unilateral incomplete eyelid closure. The incidence of Bell's palsy has increased progressively in recent years, but the underlying mechanism of its occurrence remains unknown; therefore, it is essential to investigate both the cause and treatment of Bell's palsy. Member 2 of the Subfamily V Transient Receptor Potential Cation Channel is a mechanically and thermally sensitive ion channel that plays a crucial role in neural growth and development. Using a novel modeling technique, we endeavored to develop an animal model of Bell's palsy and determine whether TRPV2 expression is altered throughout the course of a facial nerve injury.

MATERIALS AND METHODS

The rats were categorized into 3 groups, and their facial nerve function was assessed using RT-qPCR, WB, and pathologic testing, respectively, after undergoing unilateral cold air stimulation for 1, 3, and 7 days. TRPV2 expression was identified using these techniques.

RESULTS

In response to cold stimulation, rats exhibited facial nerve paralysis symptoms, demyelinating lesions in the facial nerve, and increased TRPV2 expression.

CONCLUSIONS

Extended cold stimulation of the facial nerve in rats may lead to an imbalance in facial nerve homeostasis and increased TRPV2 expression. These findings will contribute to the understanding of the potential mechanism by which cold stimulation affects the facial nerve. Moreover, this finding implies that TRPV2 could possibly function as an additional diagnostic marker or therapeutic target in the context of Bell's palsy.

The Systemic Inflammatory Response Index as a Novel Diagnostic Indicator for Bell's Palsy

Aims/Background The systemic inflammatory response index (SIRI), an emerging hematological marker of inflammation, has shown promise as a promising biomarker for a variety of inflammatory conditions. This study aims to explore the diagnostic role of SIRI in Bell's palsy (BP). Methods For this retrospective study, 73 people diagnosed with BP between January 2021 and December 2023 were recruited, along with 73 healthy controls who were age- and sex-matched. The SIRI and other blood inflammatory markers, including the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), were determined for all participants, by enumerating their peripheral blood cell counts. Facial nerve function was assessed upon admission and after one month of treatment using the House-Brackmann Facial Nerve Grading System (H-B). According to this system, patients with an H-B grade of 1-2 are considered recovered, while those with an H-B grade of 3-6 are regarded as not recovered. Results The SIRI (0.94 vs 0.48, p < 0.001), SII (480.3 vs 329.12, p < 0.001), NLR (2.42 vs 1.41, p < 0.001), and PLR (141.05 vs 117.28, p = 0.001) showed a significant increase in the BP group compared to the control group. The receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) for SIRI was higher than those for SII, NLR, and PLR, respectively. Upon one-month follow-up, significant differences in the values of SIRI, SII, and NLR were observed between the favorable prognosis group and the poor prognosis group (SIRI: 1.07 vs 0.87, p = 0.011; SII: 647.85 vs 422.11, p = 0.005; NLR: 3.31 vs 2.11, p = 0.013). The AUC of ROC curve for SIRI was found to be lower than that of SII but higher than that of NLR. Conclusion The SIRI has the potential to be an important BP diagnostic and prognostic marker.

The Monocle Sign on 18 F-FDG PET Indicates Contralateral Peripheral Facial Nerve Palsy

BACKGROUND

The aim of our study was to retrospectively analyze FDG PET/CT data in patients with facial nerve palsy (FNP) for the presence of the monocle sign.

PATIENTS AND METHODS

A total of 85 patients with unilateral FNP were included into our study, thereof 73 with peripheral FNP and 12 with central FNP. FDG uptake (SUV max , SUV mean , total lesion glycolysis) was measured in both orbicularis oculi muscles (OOMs). FDG uptake of paretic and nonparetic muscles was compared in patients with FNP (Wilcoxon test and Mann-Whitney U test) and was also compared with FDG uptake in 33 patients without FNP (Mann-Whitney U test). SUV max ratios of OOM were compared. A receiver operating characteristic curve and Youden Index were used to determine the optimal cutoff SUV max ratio for the prevalence of contralateral peripheral FNP.

RESULTS

The SUV max ratio of OOM was significantly higher in patients with peripheral FNP compared with patients with central FNP and those without FNP (1.70 ± 0.94 vs 1.16 ± 0.09 vs 1.18 ± 0.21, respectively; P < 0.001). The SUV max ratio of OOM yielded an area under the curve (AUC) of 0.719 (95% confidence interval, 0.630-0.809), with an optimal cutoff of 1.41, yielding a specificity of 94.4% and a sensitivity of 44.1% for identifying contralateral peripheral FNP. One hundred percent specificity is achieved using a cutoff of 1.91 (sensitivity, 29.4%).

CONCLUSIONS

Asymmetrically increased FDG uptake of the OOM (the "monocle sign") indicates contralateral peripheral FNP. A nearly 2-fold higher SUV max represents a practically useful cutoff.

A Natural Approach to Bell's Palsy: An Osteopathic Treatment Option

Bell's palsy (BP) is a rapid-onset neurological disorder causing unilateral facial paralysis, affecting approximately 40,000 people annually in the United States. Suggested treatments for BP include corticosteroids, facial therapy, and osteopathic manipulative treatment (OMT) in order to improve symptoms; however, some people with BP have spontaneous resolution. A 52-year-old female with left-sided facial paralysis and drooping for the past four months due to BP presented to the osteopathic treatment center. For the first three weeks after developing BP, the patient had soreness when attempting to move her facial features, but on later treatments, she only experienced weakness on the left side of her face. The patient's facial sensation was intact bilaterally, but she was unable to move her left eyebrow, eyelid, cheek, and lip. OMT focused on the intraoral musculature, the cervical spine, and cranial treatment utilizing osteopathic techniques such as osteopathic cranial manipulative medicine (OCMM), direct myofascial release, soft tissue, balanced ligamentous tension, and muscle energy. Utilizing the Facial Disability Index (FDI) questionnaire and the Sunnybrook facial grading system (SFGS), an improvement in facial paralysis was seen due to both OMT and physical therapy (PT) treatments. It is difficult to discern which treatments helped the patient the most (OMT, PT, or at-home exercises); however, the patient's improvement was notable. This case study demonstrates that OMT, PT, and at-home exercises may positively contribute toward the improvement of BP symptoms by addressing cranial and muscular somatic dysfunctions of the head and neck. The treatment, which included techniques such as muscle energy and intraoral myofascial release, resulted in significant improvements in facial function and grading scores. One limitation of the study is that, however unlikely, chronic BP may resolve spontaneously, which may have contributed to the patient's progress. While OMT, PT, and at-home exercises contributed to the patient's recovery, further research is needed to substantiate the effectiveness of OMT, PT, and at-home exercises in treating BP.

Serum Magnesium Concentration in Patients With Bell's Palsy: A Case-Control Study

Introduction: Some conditions such as hyperglycemia, preeclampsia, migraine, inflammation, oxidative stress, and peripheral neuropathy are associated with magnesium deficiency and Bell's palsy. To date, however, studies have not addressed serum magnesium concentration in patients with Bell's palsy. In this article, we hypothesized that these patients may have a decreased serum magnesium concentration compared to healthy controls. Materials and Methods: In the study, a total of 24 patients with Bell's palsy and 24 healthy individuals matched were investigated. Atomic absorption spectrometry was used to determine serum magnesium concentration. The groups were then statistically compared for demographics and serum magnesium concentration. Results: No significant differences were found between Bell's palsy patients and healthy controls in age (P = .846), sex (P = 1.0), and body mass index (P = .410). However, patients with Bell's palsy had significantly lower serum magnesium levels (µg/dL) compared to healthy controls [11.44 ± 1.54 (8.9-15.8)] versus [27.35 ± 2.82 (24.3-36.2); (P < .001)]. Conclusions: Our results suggest an association between decreased serum magnesium concentration and Bell's palsy. However, this is the first study on the topic and its limitations should be considered.

Risk factors for nonidiopathic and idiopathic facial nerve palsies: findings of a retrospective study

BACKGROUND

Idiopathic (IF) and nonidiopathic facial (NIF) nerve palsies are the most common forms of peripheral facial nerve palsies. Various risk factors for IF palsies, such as weather, have been explored, but such associations are sparse for NIF palsies, and it remains unclear whether certain diagnostic procedures, such as contrast agent-enhanced cerebral magnetic resonance imaging (cMRI), are helpful in the differential diagnosis of NIF vs. IF.

METHODS

In this retrospective, monocentric study over a five-year period, the medical reports of 343 patients with peripheral facial nerve palsy were analysed based on aetiology, sociodemographic factors, cardiovascular risk factors, consultation time, diagnostic procedures such as cMRI, and laboratory results. We also investigated whether weather conditions and German Google Trends data were associated with the occurrence of NIF. To assess the importance of doctors' clinical opinions, the documented anamneses and clinical examination reports were presented and rated in a blinded fashion by five neurology residents to assess the likelihood of NIF.

RESULTS

A total of 254 patients (74%) had IF, and 89 patients (26%) had NIF. The most common aetiology among the NIF patients was the varicella zoster virus (VZV, 45%). Among the factors analysed, efflorescence (odds ratio (OR) 17.3) and rater agreement (OR 5.3) had the highest associations with NIF. The day of consultation (Friday, OR 3.6) and the cMRI findings of contrast enhancement of the facial nerve (OR 2.3) were also risk factors associated with NIF. In contrast, the local weather, Google Trends data, and cardiovascular risk factors were not associated with NIF.

CONCLUSION

The findings of this retrospective study highlight the importance of patient history and careful inspections to identify skin lesions for the differential diagnosis of acute facial nerve palsy. Special caution is advised for hospital physicians during the tick season, as a surge in NIF cases can lead to a concomitant increase in IF cases, making it challenging to choose adequate diagnostic methods.

Unveiling Unilateral Bell's Palsy: A Case Series

Bell's palsy is an idiopathic and uncommon peripheral nerve palsy that affects the facial nerve, leading to an inability to control the muscles of facial expression on the affected side. This paper presents two cases of unilateral Bell's palsy in female patients treated with systemic steroids, antiviral drugs, and artificial tear substitutes. The treatment outcomes, clinical course, and recovery timelines are discussed in detail. A review of the current literature on the etiology, diagnosis, and management of Bell's palsy is also provided to contextualize these cases within broader clinical practice.

Non-Linear Association Between Climatic Parameters and Bell's Palsy Prevalence of Hospital Outpatients: An Ecological Proof in Kunshan, Suzhou, China

Objective

This study aimed to explore the relationship between climatic parameters and the daily cases of Bell's palsy (BP) among hospital outpatients, providing ecological evidence for understanding BP etiology and prevention.

Methods

Retrospective analysis was conducted on data from 2187 BP patients who attended Kunshan First People's Hospital Outpatient Clinic from January 1, 2020, to December 31, 2022. Meteorological data, including temperature, relative humidity, precipitation, wind speed, sunshine duration, and atmospheric pressure, were collected and combined with daily BP case records. Additionally, air quality index was used as a covariate.

Results

The number of new BP cases among outpatients showed a negative correlation with average daily temperature. A nonlinear relationship between daily average temperature and BP cases was observed through the generalized additive model (GAM). A significant negative correlation was identified between daily average temperature and BP cases, with inflection points at temperatures above 4.2°C, suggesting a potential decrease in BP risk with temperature rise beyond this threshold.

Conclusion

This study provides ecological evidence of a link between climatic factors and BP occurrence. Temperature demonstrated a significant nonlinear negative correlation with daily BP incidence, highlighting temperature and cold exposure as key targets for BP prevention in Kunshan.

Effectiveness of novel facial stretching with structured exercise versus conventional exercise for Bell's palsy: a single-blinded randomized clinical trial

The purpose of the study was to assess the effects of a novel technique involving facial stretching of the unaffected side along with a structured exercise for the affected side on facial symmetry and facial functions as compared to conventional exercise. A hospital-based parallel-group randomized trial was completed among patients with acute Bell's palsy in Mangalore, India. Participants were randomized to receive facial stretching and a structured exercise program (experimental group) or the conventional exercise regimen (conventional group). Primary outcomes were facial symmetry and voluntary movement; assessed by the Sunnybrook Facial Grading System (SFGS). Both regimens were given for 3 weeks, with baseline, 10th day, and 20th day assessments. Out of 31 participants screened, 24 were eligible and 12 participants each were assigned to experimental and conventional groups. Change scores revealed greater improvement in the SFGS score (p = 0.002) for the experimental group participants. Facial stretching and structured exercise program exhibited promising results in enhancing facial symmetry and function in acute Bell's palsy when compared to conventional exercise regimen.

Predictive Value of the Neutrophil-to-Lymphocyte Ratio and C-Reactive Protein in Patients with Idiopathic Facial Nerve Palsy

Objective

This study aims to investigate the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in patients with idiopathic facial nerve palsy.

Methods

The clinical data of patients with idiopathic facial nerve palsy were retrospectively analyzed. After three months of follow-up, patients were divided into good prognosis and poor prognosis, and the correlation between NLR, CRP and idiopathic facial nerve palsy was analyzed.

Results

Negative correlation of NLR with Portmann score in idiopathic facial nerve palsy (r=-0.788, P<0.05); In contrast to the group with poor prognosis, patients in good prognosis group had low levels of body mass index (BMI), NLR, and C-reactive protein (CRP), and high Portmann score (P<0.05); Multivariate logistic regression analysis showed Portmann score (OR=1.268, 95% CI (1.005-1.616)), NLR (OR=0.262, 95% CI (0.128-0.533)) and CRP levels (OR=0.949, 95% CI (0.895-0.989)) were risk factors of poor prognosis for patients with idiopathic facial nerve palsy. The area under the receiver operator characteristic (ROC) curve of NLR and CRP levels in predicting poor facial nerve function was 0.764 and 0.697, the specificity was 85.5% and 75.0%, and the sensitivity was 74. 0% and 76.0%, respectively. The ROC curve of the combined diagnosis was 0.829, the specificity was 80.7%, and the sensitivity was 82.0%.

Conclusion

Elevated NLR and CRP are associated with a poor prognosis of idiopathic facial nerve palsy and can serve as an indicator for clinical prognosis, and can be widely used in clinical.

West Nile Virus: A Neglected Cause of Bell's Palsy?

The West Nile virus (WNV) is the leading cause of mosquito-borne disease in the United States. Bell's palsy (BP) is a clinical syndrome associated with viral infections, but an association with West Nile virus (WNV) is not well-described, with only two cases reported in the literature. We present a case of a 68-year-old woman presenting with fevers and encephalopathy. Cerebrospinal fluid was positive for WNV. Following improvement, she developed facial weakness and was diagnosed with BP secondary to the WNV infection. Identifying BP associated with WNV infection may have significant clinical implications, but further studies are needed to fully characterize a causative relationship.

Exploring Non-invasive Therapies for Bell's Palsy: A Case Report

Unknown in origin, Bell's palsy is a common acute facial nerve paralysis that is usually characterized by unilateral facial weakening or paralysis. People of all ages are affected by this illness, which peaks in the fourth decade of life. Although the precise etiology is yet unknown, viral infections - particularly type 1 herpes simplex virus - are frequently linked to the problem. Based on the evidence of abrupt onset facial weakness and the elimination of other neurological diseases, the diagnosis is essentially clinical. The goals of management techniques are to lessen related symptoms, encourage nerve regeneration, and lessen inflammation. Corticosteroids, antiviral drugs, physical therapy, and supportive measures are available as treatment alternatives. The majority of patients experience spontaneous recovery within weeks to months, and the prognosis is generally excellent. Nonetheless, a portion may experience long-term consequences, highlighting the significance of individualized follow-up care. Bell's palsy is succinctly summarized in this abstract to aid in better comprehension and well-informed clinical practice decision-making.

Association between hypertensive disorders and Bell's palsy in pregnancy: protocol for a systematic review and meta-analysis

BACKGROUND

Bell's palsy is an idiopathic peripheral nerve palsy involving the facial nerve. Pregnancy, diabetes mellitus and hypertension are the risk factors for Bell's palsy. However, the association between hypertensive disorders and Bell's palsy during pregnancy or the puerperium remains unclear. This systematic review will comprehensively summarise the literature and evaluate the association between Bell's palsy and hypertensive disorders during pregnancy or the puerperium.

METHODS AND ANALYSIS

Systematic searches of PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials will be undertaken using prespecified search strategies. Observational studies (cross-sectional studies, cohort studies, case reports and series case reports) written in English that investigate the association between hypertensive disorders of late pregnancy and Bell's palsy during pregnancy or the puerperium will be included. Different authors will independently conduct the eligible study selection, perform data extraction and appraise the quality of included studies. Subgroup analysis will be carried out based on the age of pregnant women (≤35 years old, >35 years old), parity (primipara, multipara) and fetus number (singleton or multiple-gestation pregnancy).

ETHICS AND DISSEMINATION

This review will be based on published literature, and thus there is no requirement for ethics approval. The results of this study will aid in the knowledge of the relationship between Bell's palsy during pregnancy or the puerperium and hypertensive disorders of late pregnancy. The results of this systematic review will be shared through publication in a peer-reviewed journal with good visibility for the field of obstetrics and presentations at academic conferences.

PROSPERO REGISTRATION NUMBER

CRD42023422902.

Physiotherapy in Bell's Palsy Secondary to Acute Otitis Media: A Case Report

Acute suppurative otitis media can occasionally result in facial paralysis, which calls for prompt diagnosis and treatment. Facial paralysis, a synonym for Bell's palsy, is a condition that causes rapid weakening of one side of the face muscles, leading to drooping of the face on that side. A major factor in determining the course of the condition is rehabilitation through physiotherapy. Here, we present a case of a 26-year-old female who felt discomfort in her left ear on February 21, 2024, but chose to ignore it then. She observed an abrupt deviation in her mouth and visited a rural hospital, where she was admitted. Facial asymmetry was observed during the examination, and she was found to have a grade V on the House-Brackmann scale. A near-normal muscle action was initiated by mime therapy, and proprioceptive stimulation was given by facial proprioceptive neuromuscular facilitation along with electrical stimulation. All these approaches benefited the patient in a significant manner.

[Effect analysis of facial nerve decompression surgery in the treatment of Bell's palsy and Hunt syndrome]

Objective:To summarize and analyze the effect of facial nerve decompression surgery for the treatment of Bell's palsy and Hunt syndrome. Methods:The clinical data of 65 patients with facial nerve palsy who underwent facial nerve decompression in our center from October 2015 to October 2022 were retrospectively analyzed, including 54 patients with Bell's palsy and 11 patients with Hunter syndrome. The degree of facial paralysis（HB grade） was evaluated before surgery, and ENoG, pure tone audiometry, temporal bone CT and other examinations were completed. All patients had facial palsy with HB grade V or above after conservative treatment for at least 1 month, and ENoG decreased by more than 90%. All patients underwent facial nerve decompression surgery through the transmastoid approach within 3 months after onset of symptoms. The recovery effect of facial nerve function after surgery in patients with Bell's palsy and Hunter syndrome was summarized and analyzed. In addition, 15 cases in group A（operated within 30-60 days after onset） and 50 cases in group B（operated within 61-90 days after onset） were grouped according to the course of the disease（the interval between onset of symptoms and surgery） to explore the effect of surgical timing on postoperative effect. Results:There was no significant difference between the two groups of patients with Chi-square test（P=0.54） in 42 patients（77.8%, 42/54） with Bell's palsy and 7 patients（63.6%, 7/11） in patients with Hunter syndrome who recovered to grade Ⅰ-Ⅱ. According to the course of the disease, 10 cases（66.7%, 10/15） in group A recovered to grade Ⅰ-Ⅱ after surgery. In group B, 39 patients（78.0%, 39/50） recovered to grade Ⅰ-Ⅱ after surgery, and there was no statistically significant difference between the two groups by Chi-square test（P=0.58）. Conclusion:Patients with Bell's palsy and Hunter syndrome can achieve good results after facial nerve decompression within 3 months of onset, and there is no significant difference in the surgical effect between the two types of patients.

Comparison of the efficacy of acupuncture with tuina with acupuncture-only in the treatment of peripheral facial paralysis: a network meta-analysis

At present, traditional Chinese medicine treatment is considered safe for treating peripheral facial paralysis (PFP). Acupuncture-only and acupuncture combined with tuina are widely used for this purpose. However, it is not clear whether acupuncture combined with tuina is better for treating PFP than acupuncture-only. Conventional meta-analysis and network meta-analysis were used to compare the clinical efficacies of acupuncture combined with tuina and acupuncture-only in the treatment of PFP. Randomized controlled trials (RCTs), with the subjects being patients with PFP and treatment interventions including acupuncture combined with tuina, acupuncture-only, tuina-only, placebo, single Western medicine, and steroids combined with other Western medicine were searched from both Chinese and English databases. The primary outcomes included Modified House-Brackmann (MHBN) scores and Sunnybrook Facial Grading System, whereas the secondary outcomes included cure time, Portmann scores, and physical function scale of Facial Disability Index, using conventional meta-analysis and network meta-analysis. The study included 22 RCTs with a sample size of 1814 patients. The results of conventional meta-analysis (MD = 16.12, 95%CI 13.13,19.10) and network meta-analysis (MD = 14.53, 95%CI 7.57,21.49) indicate that acupuncture combined with tuina was better than acupuncture-only in improving MHBN and shortening the cure time (MD = - 6.09, 95%CI  - 7.70, - 4.49). Acupuncture combined with tuina was the optimal therapy for improving MHBN (SUCRA was 100%) and shortening the cure time (SUCRA was 100%). The results of this meta-analysis indicate that acupuncture combined with tuina can significantly improve MHBN and shorten the cure time, compared with acupuncture-only. However, the current evidence is insufficient, and more high-quality clinical studies are needed.Registration: This study had been registered with PROSPERO (CRD42022379395).

An integrated network pharmacology approach to discover therapeutic mechanisms of Commiphora wightii for the treatment of Bell's palsy

Bell's palsy (BP) can result in facial paralysis. Inflammation or injury to the cranial nerves that regulate the facial muscles is primarily responsible for that disease. Commiphora wightii remains recognized as a cure for a few human ailments. This study focused on therapeutic phenomena of C. wightii for the treatment of Bell's palsy, utilizing the network drug discovery and molecular docking techniques. Active biological constituents of C. wightii were retrieved from literature and independent databases. Potential therapeutic targets (431) of 13 bioactive phytochemicals were fetched via SwissTargetPrediction tool. Putative intersecting targets (855) of Bell's palsy were computed through the DisGeNET and GeneCards datasets. Subsequently, by the analysis of potential shared targets (87) of C. wightii and Bell's palsy, a Venn diagram was drawn. DAVID database was used to evaluate gene functional annotations and enriched pathways that are involved in Bell's palsy. STRING database was used for generating the protein-protein relationship complex. Visual presentations of the interactions of potential targets to active chemical constituents were done by the Cytoscape. Whereas, the conformational research sorted out 10 key targets through the protein-protein interactions network. Moreover, the capacity of therapeutic ingredients to interact with a target inhibiting Bell's palsy was confirmed by molecular docking, which might ratify the findings of network pharmacology. In the molecular complex of AKT1-cholesterol, a 100-ns simulation unveiled a graceful stability, with a minimal 0.167 Å ligand shift and resilient hydrogen bonds (ASN54 and SER205). The final 20 ns showcased a P1 motif pirouette, gracefully forming aromatic bonds with H165 and W186, underscoring the complex's dynamic finesse. This study evaluated compound-target interactions and their impact on disease-related genes. It revealed that five genes (AKT1, TNF, MAPK3, EGFR and SRC) of C. wightii might be useful therapeutic targets for the treatment of Bell's palsy, as well as helping in lowering down the blood pressure.Communicated by Ramaswamy H. Sarma.

A Retrospective Review of Seasonal Patterns of Idiopathic Facial Nerve Paralysis in a Tertiary Care Center

Background The objective of this retrospective study was to investigate the seasonal patterns of idiopathic facial nerve paralysis, specifically Bell's palsy, in Riyadh, Saudi Arabia. The study aimed to determine if there is a correlation between cold weather and the incidence of Bell's palsy, as well as to examine the relationship between age, gender, comorbidities, and the development of the disease. Methodology Data were collected from King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2016 and 2021. Electronic medical records of adult patients diagnosed with idiopathic facial paralysis were reviewed. Patients with facial paralysis caused by known illnesses were excluded. Demographic information, clinical characteristics, and the course of the disease were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA). Results The study included 136 Bell's palsy patients, with a mean age of 39.9 years. Males represented 58.1% (79) of the sample, and the right side of the face was more commonly affected in 71 (52.2%) patients. The majority of patients had House-Brackmann grade III (51, 37.5%). The monthly distribution showed a higher number of Bell's palsy cases during the winter months, particularly December, October, and November, but the seasonal distribution did not yield a statistically significant difference in incidence. Conclusions While this study observed a higher incidence of Bell's palsy during the winter months, it did not establish a statistically significant correlation between cold temperatures and the onset of Bell's palsy in Riyadh, Saudi Arabia. Furthermore, the study found that Bell's palsy predominantly affects middle-aged males, and comorbidities did not appear to be significant risk factors for the development of the disease. This research lays the groundwork for future investigations into the relationship between weather and the pathogenesis of Bell's palsy in the region.

Serum levels of heavy metals in patients with Bell's palsy: a case-control study

PURPOSE

The exact etiology of Bell's palsy (BP) remains unknown, while its potential etiopathology includes neuritis and inflammation-related demyelination as in optic neuritis. It has been reported that disruption of heavy metal homeostasis may be associated with the inflammatory process of optic neuritis; therefore, heavy metals may be involved in the pathogenesis of facial nerve neuritis. In this study, we aimed to investigate serum levels of heavy metals including essential elements [iron (Fe), zinc (Zn), copper (Cu), cobalt (Co), and manganese (Mn)], and nonessential elements [lead (Pb) and cadmium (Cd)] in patients with BP.

METHODS

The study included 25 patients with BP and 31 healthy volunteers. For each participant, serum levels of essential and nonessential elements were measured using the atomic absorption spectrophotometer method.

RESULTS

Serum levels of essential elements were significantly lower in the patient group compared to the control group (p < 0.001, for each). Serum levels of Pb increased in the patient group compared to the control group although no significant difference was achieved (p = 0.105). In contrast, serum Cd levels increased significantly in the patient group compared to the control group (p < 0.001).

CONCLUSION

Our findings suggest that decreased essential and increased nonessential elements may be associated with BP and thus, serum concentrations of these elements should be taken into account in BP. Studies are warranted to determine the role of these elements in treatment of BP.

Prevalence, Etiology, Risk Factors, and Complications of Facial Nerve Palsy at King Abdulaziz Medical City: A Multicenter Study

BACKGROUND

Facial nerve palsy is a condition of nerve damage that results in impaired facial movement on one or both sides of the face.

OBJECTIVES

This multicenter study aimed to determine the prevalence of facial nerve palsy and evaluate the association between its risk factors and complications to identify its etiology among patients admitted to King Abdulaziz Medical City in Jeddah and Riyadh, Saudi Arabia, between 2016 and 2023.

METHODS

A retrospective cross-sectional study was conducted to obtain data from medical records using the best care system for patients with facial nerve palsy. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States), Chi-square test, t-test, and ANOVA. The level of statistical significance was set at p<0.05.

RESULTS

 The study involved 123 patients, with 0.0164% prevalence. Bell's palsy was the most common etiology, accounting for 81.8% of cases, followed by head injuries, dental trauma, otitis media, stroke, and head and neck tumors. Obesity was the most significant risk factor, followed by upper respiratory problems. Hypertension and diabetes exert similar effects. Facial asymmetry, ophthalmic complications, and eye twitching were the most common complaints followed by speech difficulties, psychological and social effects, mouth twitching, and synkinesis.

CONCLUSION

 Facial nerve palsy is common in this region. We recommend health education sessions to increase public awareness and provide preventive strategies to reduce the complications of facial nerve damage. We recommend further research on the association between the risk factors and complications of facial nerve palsy.

Bell's palsy: a case report of unusual presentation in a patient with rhino-orbital cerebral mucormycosis

BACKGROUND

Mucormycosis is a fungal infection caused by the Mucorales order of fungi. This fungus is commonly found in soil and can cause disease in immunocompromised patients. On the other hand, Bell's palsy is an idiopathic condition that results in the sudden onset of unilateral facial muscle weakness, affecting the facial nerve.

CASE PRESENTATION

A 51-year-old Persian housewife with a history of poorly controlled diabetes mellitus presented with a splitting headache that had been ongoing for 1 week and an inability to close her left eye or make facial expressions on the left side of her face. The patient's vital signs were normal, but physical examination revealed a yellow-grey scar on the left side of her hard palate and Bell's palsy on the left side. A neurological examination showed that she could move both eyes but could not close her left eye, move up her left eyebrow, or smile. Further investigations were performed, including laboratory tests, radiologic imaging, and functional endoscopic sinus surgery. The patient underwent three rounds of debridement for bony erosion in the medial and posterior walls of the left maxillary sinus and the hard palate. Pathological examination confirmed mucormycosis infection in the hard palate and mucosa.

CONCLUSION

Fungal infection must be considered a potential diagnosis for immunocompromised adults who exhibit symptoms of Bell's palsy.

Laser acupuncture and photobiomodulation therapy in Bell's palsy with a duration of greater than 8 weeks: a randomized controlled trial

To investigate the efficacy of laser acupuncture and photobiomodulation therapy in alleviating symptoms among patients diagnosed with Bell's palsy with duration of greater than 8 weeks. The randomized controlled trial has been performed from May 2021 to April 2023. Patients were eligible who had Bell's palsy with duration of greater than 8 weeks on out-patient Department of Otorhinolaryngology in Beijing Tongren Hospital. The laser acupuncture group received class IV laser treatment for 3 times per weeks, a total of 72 times. The control group received the same treatment procedure except the laser parameter. The primary outcome measures comprised House-Brackmann facial nerve grading system and electroneurography. Secondary outcome measures comprised Sunnybrook facial grading system, electromyography, and the blink reflex. A total of 84 participants were included (42 control group, 42 laser acupuncture group). After treatment, House-Brackmann facial nerve grading system (OR, 0.11; 95% CI, 0.04-0.30; P < 0.001), and the pathologic numbers of electroneuronography were statistically different between the laser acupuncture group and control group, including orbicularis oculi (OR,0.08; 95% CI, 0.02-0.21; P < 0.001), Frontalis muscle (OR,0.14; 95% CI, 0.05-0.39; P < 0.001), Orbicularis oris (OR,0.13; 95% CI, 0.04-0.36; P < 0.001), Ala nasi muscle (OR,0.06; 95% CI, 0.02-0.18; P < 0.001). In secondary outcomes, Sunnybrook facial grading system, has significant difference between the two groups (20.26; 95% CI, 14.69 to 25.83; P < 0.01). Latency by ENoG, include orbicularis oculi (-0.61; 95% CI, -0.43 to -0.09; P < 0.001), frontalis muscle (-0.12; 95% CI, -0.21 to -0.03; P < 0.01), orbicularis oris (-0.28; 95% CI, -0.41 to -0.16; P < 0.001), and ala nasi muscle (-0.26; 95% CI, -0.38 to -0.16; P < 0.001). All amplitudes of MUAPs and durations by electromyography (EMG) showed statistically significant differences compared with the control group after treatment. For the frontalis muscle, the amplitude of MUAPs was -64.23 (95% CI, -80.89 to -47.56; P < 0.001) and duration was -1.18 (95% CI, -1.49 to -0.87; P < 0.001). For orbicularis oris, amplitude of MUAPs was -29.82 (95% CI, -55.03 to -4.62; P = 0.02) and duration was -0.57 (95% CI, -0.94 to -0.20; P < 0.001). For depressor angulli oris, amplitude of MUAPs was -47.06 (95% CI, -62.15 to -31.97; P < 0.001) and duration was -2.21 (95% CI, -2.69 to -1.72; P < 0.001). Blink reflex, including R1 (OR, 0.03; 95% CI, 0.01-0.16; P < .001), R2 (OR, 0.04; 95% CI, 0.004-0.29; P < .001), and R2 latency differences (OR, 0.15; 95% CI, 0.05-0.51; P < .001), have significant difference between the two groups, respectively. The findings suggest that laser acupuncture relieve symptoms for patients with Bell's palsy with a duration of greater than 8 weeks.Trial registration: ClinicalTrials.gov Identifier: NCT05846217.

Bell Palsy: Facts and Current Research Perspectives

Bell palsy is a non-progressive neurological condition characterized by the acute onset of ipsilateral seventh cranial nerve paralysis. People who suffer from this type of facial paralysis develop a droop on one side of their face, or sometimes both. This condition is distinguished by a sudden onset of facial paralysis accompanied by clinical features such as mild fever, postauricular pain, dysgeusia, hyperacusis, facial changes, and drooling or dry eyes. Epidemiological evidence suggests that 15 to 23 people per 100,000 are affected each year, with a recurrence rate of 12%. It could be caused by ischaemic compression of the seventh cranial nerve, which could be caused by viral inflammation. Pregnant women, people with diabetes, and people with respiratory infections are more likely to have facial paralysis than the general population. Immune, viral, and ischemic pathways are all thought to play a role in the development of Bell paralysis, but the exact cause is unknown. However, there is evidence that Bell's hereditary proclivity to cause paralysis is a public health issue that has a greater impact on patients and their families. Delay or untreated Bell paralysis may contribute to an increased risk of facial impairment, as well as a negative impact on the patient's quality of life. For management, antiviral agents such as acyclovir and valacyclovir, and steroid treatment are recommended. Thus, early diagnosis accompanied by treatment of the uncertain etiology of the disorder is crucial. This paper reviews mechanistic approaches, and emerging medical perspectives on recent developments that encounter Bell palsy disorder.

Bell's Palsy and COVID-19: Insights from a Population-Based Analysis

Background: Coronavirus disease 2019 (COVID-19) has been linked to Bell's palsy and facial paralysis. Studies have also shown increased risk of Bell's palsy in unvaccinated COVID-19 patients. Objective: To compare the relationship between Bell's palsy and COVID-19 infection and vaccination. Design: This is a retrospective longitudinal study. Methods: The COVID-19 research network was used to identify patients with facial palsy presenting to 70 health care organizations in the United States. The incidence of Bell's palsy was measured within an 8-week window after COVID-19 test or vaccination event in identified patients. Results: Incidence of facial palsy diagnosis (0.99%) was higher than the background rate within 2 months of COVID-19 infection. When compared with their negative counterparts, patients with COVID-19 infection had significantly higher risk of Bell's palsy (risk ratio [RR] = 1.77, p < 0.01) and facial weakness (RR = 2.28, p < 0.01). Risk ratio was also amplified when evaluating Bell's palsy (RR = 12.57, p < 0.01) and facial palsy (RR = 44.43; p < 0.01) in COVID-19-infected patients against patients who received COVID-19 vaccination. Conclusion: In our patient population, there is a higher risk of developing facial palsy within 2 months of COVID-19 infection versus vaccination. Vaccinated patients are not at higher risk of developing facial palsy.

Extra-axial cranial nerve enhancement: a pattern-based approach

Cranial nerve enhancement is a common and challenging MRI finding that requires a meticulous and systematic evaluation to identify the correct diagnosis. Literature mainly describes the various pathologies with the associated clinic-radiological characteristics, while the radiologist often needs a reverse approach that starts from the radiological findings to reach the diagnosis. Therefore, our aim is to provide a new and practical pattern-based approach to cranial nerve enhancement, which starts from the radiological findings and follows pattern-driven pipelines to navigate through multiple differential diagnoses, guiding the radiologist to reach the proper diagnosis. Firstly, we reviewed the literature and identified four patterns to categorize the main pathologies presenting with cranial nerve enhancement: unilateral linear pattern, bilateral linear pattern, unilateral thickened pattern, and bilateral thickened pattern. For each pattern, we describe the underlying pathogenic origin, and the main radiological features are displayed through high-quality MRI images and illustrative panels. A suggested MRI protocol for studying cranial nerve enhancement is also provided. In conclusion, our approach for cranial nerve enhancement aims to be an easy tool immediately applicable to clinical practice for converting challenging findings into specific pathological patterns.

Progress in treatment of facial neuritis by acupuncture combined with medicine from the perspective of modern medicine: A review

Facial neuritis is a common clinical disease with high incidence, also known as Bell palsy or idiopathic facial nerve paralysis, which is an acute onset of peripheral facial neuropathy. In modern medicine, there have been obstacles to the effective treatment of facial neuritis. At present, the clinical use of Western medicine treatment is also a summary of clinical experience, the reason is that the cause of facial neuritis is unknown. Facial neuritis belongs to the category of "facial paralysis" in traditional Chinese medicine. For thousands of years, Chinese medicine has accumulated a lot of relevant treatment experience in the process of diagnosis and treatment. At the same time, traditional Chinese medicine, acupuncture and the combination of acupuncture and medicine play an important role in the treatment of facial neuritis. This article discusses the treatment of facial neuritis with acupuncture combined with Chinese medicine, based on the research progress of modern medicine. In this review, we provide an overview of the effectiveness of acupuncture and medication combinations and facial neuritis with current studies investigating acupuncture and medication combinations in the treatment of facial neuritis.

Optimal Bell's Palsy Treatment: Steroids, Antivirals, and a Timely and Personalized Approach

IMPORTANCE

The optimal treatment approach for patients with Bell's palsy, a condition characterized by acute facial nerve palsy, remains unclear. The present study was designed to provide insights into the most effective treatment strategies, whether steroids alone or steroids plus antiviral agents, as well as the optimal timing of treatment initiation.

OBJECTIVE

To investigate the impact of treatment modalities and timing on the recovery rates of Bell's palsy patients and to assess the roles of individual factors.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective analysis included 1504 patients with Bell's palsy who visited Kyung Hee University Hospital. Patients were divided based on the treatment modality (steroid monotherapy vs. combined steroid and antiviral therapy) and the timing of treatment initiation (≤72 vs. >72 h).

MAIN OUTCOMES AND MEASURES

The primary outcome was the recovery rate, as assessed by the House-Brackmann (HB) grade. Secondary outcomes included factors such as age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions.

RESULTS

A combined comparison of patients treated with steroids plus antivirals and steroids alone, stratified by treatment start time, showed that recovery rates were highest in patients who received steroid monotherapy initiated within 72 h (OR 2.36; p < 0.05). Patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 h. The recovery rate was higher in patients who received steroid monotherapy than combined therapy (86.32% vs. 79.25%, p < 0.05). Initiating treatment beyond 72 h was associated with a higher recovery rate than starting treatment within 72 h (85.69% vs. 76.92%, p < 0.05). An evaluation of the factors affecting recovery showed that patients aged 20 to 39 years had a higher recovery rate than other age groups (OR 1.47; p < 0.05). Fairly predictive EMG results were associated with significantly higher recovery rates (OR 3.52; p < 0.05).

CONCLUSIONS

These findings underscore the importance of individualized treatment approaches in Bell's palsy management. Steroid monotherapy remains effective, although combined treatment may have potential advantages, especially in patients with more severe disease. The best treatment results were achieved when steroid treatment was administered within 72 h. Our results suggest that there may be more flexibility in the application of the 72 h treatment period if we consider the time of treatment initiation alone, but this should take into account patient behavior patterns and the limitations of retrospective analysis. Further research is warranted to validate these findings and refine treatment recommendations for patients with Bell's palsy.

Effect of neural mobilisation in Bell's palsy: A randomised controlled trial

Background

Neural mobilisation technique is effective in spinal nerve rehabilitation. However, no study has reported the effect of facial nerve mobilisation in acute Bell's palsy.

Objectives

The objective of our study was to evaluate the effect of facial neural mobilisation over conventional therapy in improving facial symmetry in patients with acute Bell's palsy.

Methods

A randomised controlled trial was conducted in the physical therapy department for 62 patients with acute Bell's palsy. The intervention included 10 days of drug therapy including 3 weeks of conventional therapy to the experimental and the control group. However, the experimental group received additional nerve mobilisation technique aimed at mobilising the facial nerve at the origin of external auditory meatus. All participants were assessed at baseline and after three weeks using the Sunnybrook facial grading system (SBS) and Kinovea Movement Analysis Software (KMAS).

Results

For primary outcome, analysis of covariance with baseline data as covariate showed a significant difference between groups for the post-test mean scores of SBS after 3 weeks (between-group difference, 9.2 [95% CI, 5.1-13.3], p = 0 . 001 . Importantly, the effect size calculated by partial η 2 for neural mobilisation was 0.258 (small effect size). For secondary outcomes, independent sample t-test showed a significant difference between groups for the scores on KMAS after 3 weeks for zygomatic muscle (between-group difference, - 27 . 2 [95% CI, - 31 to - 22 . 6 ], p = 0 . 001 ), frontalis muscle - 16 . 7 [95% CI, - 9 . 9 to - 23 . 4 ], p = 0 . 001 , and orbicularis oris muscle - 15 . 0 [95% CI, - 11 . 1 to - 18 . 8 ], p = 0 . 001 .

Conclusion

Facial neural mobilisation is likely to be an effective adjunctive intervention in addition to conventional therapy in improving facial symmetry in acute Bell's palsy.

Functional characterisation of the ACE2 orthologues in Drosophila provides insights into the neuromuscular complications of COVID-19

SARS-CoV-2, the virus responsible for the coronavirus disease of 2019 (COVID-19), gains cellular entry via interaction with the angiotensin-converting enzyme 2 (ACE2) receptor of host cells. Although SARS-CoV-2 mainly targets the respiratory system, the neuromuscular system also appears to be affected in a large percentage of patients with acute or chronic COVID-19. The cause of the well-described neuromuscular manifestations resulting from SARS-CoV-2 infection remains unresolved. These may result from the neuromuscular-invasive capacity of the virus leading to direct injury. Alternatively, they may be the consequence of ACE2 inactivation either due to viral infection, ACE2 autoantibodies or both. Here, we made use of the Drosophila model to investigate whether ACE2 downregulation is sufficient to induce neuromuscular phenotypes. We show that moderate gene silencing of ACE2 orthologues Ance or Ance3 diminished survival on exposure to thermal stress only upon induction of neuromuscular fatigue driven by increased physical activity. A strong knockdown of Ance or Ance3 directed to muscle reduced or abolished adult viability and caused obvious motoric deficits including reduced locomotion and impaired flight capacity. Selective knockdown of Ance and Ance3 in neurons caused wing defects and an age-dependent decline in motor behaviour, respectively, in adult flies. Interestingly, RNA sequencing allowed us to discover several differentially spliced genes that are required for synaptic function downstream of Ance or Ance3 depletion. Our findings are therefore supportive of the notion that loss of a RAS-independent function for ACE2 contributes to the neuromuscular manifestations associated with SARS-CoV-2 infection.

Contrast-enhanced MRI findings of patients with acute Bell palsy within 7 days of symptom onset: A retrospective study

The brain magnetic resonance imaging (MRI) findings seen in patients with Bell palsy are abnormal contrast enhancement of affected facial nerves. Previous studies were conducted on a few patients, mainly those who had experienced palsy for several weeks. This study investigated the diagnostic usefulness of MRI by examining MRI findings of acute Bell palsy (within 7 days of symptom onset) in a large cohort. Among the patients with Bell palsy (idiopathic unilateral facial palsy) who visited the hospital, 123 patients who underwent contrast-enhanced MRI of the internal auditory canal within 7 days of symptom onset were reviewed retrospectively. MRI examination results were investigated along with the patient's clinical symptoms and electrodiagnostic test results. Based on the MRI results, the frequency of abnormal contrast enhancement and contrast-enhanced areas were investigated. Of the 123 patients, 13 (11%) had normal brain MRI results, and 110 (89%) had abnormal findings. The frequency of abnormal contrast enhancement was not significantly associated with test timing (P = .56). Of the 110 patients with abnormal findings, 65 (59%) showed contrast enhancement in the labyrinthine segment and 36 (33%) in both the labyrinthine segment and geniculate ganglion. Most patients with Bell palsy who are in the acute phase showed abnormal contrast enhancement in their facial nerves, and similar findings were even observed in the examination conducted on the day of symptom onset. Brain MRI helps in the diagnosis of acute Bell palsy.

Bell's Palsy Unmasked: A Compelling Case Study of Facial Nerve Palsy During Pregnancy

Facial paralysis occurs more frequently in pregnant individuals, affecting them two to four times more often than those who are not pregnant, making it the most frequent unilateral cranial nerve pathology in pregnancy. This case report describes a 29-year-old primigravida's presentation, examination, and treatment of left-sided (unilateral) facial nerve palsy during 32 weeks of gestation. Concerns regarding possible underlying reasons were raised when the patient suddenly developed left-side facial weakness. We examined her history, clinical assessment, and diagnosis methods, which included laboratory and neuro-imaging tests. The difficulties of managing this illness during pregnancy are explored, taking into account the well-being of the developing fetus and mother. There are several causes for facial nerve palsy during pregnancy, including idiopathic causes, vascular problems, and viral infections. Here, we emphasize the value of a multidisciplinary approach comprising obstetricians, neurologists, and other medical professionals to guarantee the best possible care. The paper also underscores the necessity for prompt diagnosis and suitable interventions to reduce problems and foster a successful outcome. This case report adds to the limited literature on facial nerve palsy in pregnancy by highlighting individualized medical care and teamwork in addressing this uncommon but serious condition.

Bell's palsy was associated with TRPV2 downregulation of Schwann cell by cold stress

OBJECTIVE

Epidemiological and clinical studies have shown that sharp changes in the ambient temperature are associated with the occurrence and development of Bell's palsy. However, the specific pathogenesis of peripheral facial paralysis remains nebulous. This study investigated the effect of cold stress on transient receptor potential cation channel subfamily V member 2 (TRPV2) secretion by Schwann cells and its role in Bell's palsy.

MATERIALS AND METHODS

Schwann cell morphology was observed using transmission electron microscopy (TEM). Cell proliferation, apoptosis and cell cycle were analysed using CCK8 and flow cytometry. ELISA, Reverse transcription-quantitative PCR, western blotting and immunocytochemical fluorescence staining were used to detect the effects of cold stress on TRPV2, neural cell adhesion molecule (NCAM) and nerve growth factor (NGF) expression in Schwann cells.

RESULTS

Cold stress resulted in a widening of the intercellular space, and the particles on the membrane showed different degrees of loss. Cold stress may cause Schwann cells to enter a cold dormant state. ELISA, RT-qPCR, western blotting and immunocytochemical fluorescences staining indicated that cold stress inhibited the expression of TRPV2, NCAM, and NGF.

CONCLUSIONS

Drastic temperature difference between cold and heat can downregulate TRPV2 and the secretome of Schwann cells. The imbalance of Schwann cell homeostasis under such stress may contribute to nerve signalling dysfunction leading to the development of facial paralysis.

Effect of temperature and air pressure on the incidence of Bell's palsy in Hangzhou: a distributed lag non-linear analysis

The etiology of Bell's palsy (BP) is currently unknown, and the findings from previous studies examining the association between seasonal or meteorological factors and BP have been inconsistent. This research aims to clarify this relationship by analyzing a larger dataset and employing appropriate statistical methods. Data from 5387 patients with BP treated at Zhejiang Provincial Hospital of Traditional Chinese Medicine in Hangzhou, Zhejiang Province, from May 1, 2018, to June 30, 2023, was gathered. We assessed the temporal distribution of meteorological factors and the incidence of BP across seasons and months. A distributed lag non-linear model was used to further investigate the lagged and overall effects of temperature and air pressure on the onset of BP. The temporal distribution of BP incidence revealed the highest average number of cases occurring in December and the lowest in June. A correlation existed between BP episodes and temperature or air pressure. The model revealed a higher relative risk during periods of low temperature and high air pressure, characterized by a time lag effect. This correlation was notably more pronounced in female patients and individuals in the young and middle-aged groups. Our findings suggest that exposure to low temperatures and high air pressure constitute risk factors for BP development.

Examining the relationship between COVID-19 and Bell's palsy: Experience of a single tertiary care center

BACKGROUND

While the etiology of Bell's palsy (BP) is largely unknown, current evidence shows it may occur secondary to the immune response following a viral infection. Recently, BP has been reported as a clinical manifestation of coronavirus disease (COVID-19).

OBJECTIVES

To investigate an association between COVID-19 infection and BP. Additionally, to evaluate the need for COVID-19 testing in patients who present with BP.

METHODS

Hospital records of patients who presented to a single tertiary care center with BP in 2020 and 2021 were reviewed for presenting symptoms, demographics, COVID-19 infection and vaccination status.

RESULTS

There was no statistically significant difference between patients with BP who had a positive or negative COVID test in terms of sex, BMI, age, race, smoking history or alcohol use. All 7 patients with BP and a positive COVID test were unvaccinated. Of the total cohort of 94 patients, 82 % were unvaccinated at the time of the study. None of the 17 patients who were vaccinated had a positive COVID test. A history of BP showed no statistical significance (10.3 % vs 14.3 %, p-value 0.73).

CONCLUSION

We discovered a limited cohort of patients who underwent COVID-19 testing at the time of presentation for BP. Though there have been recent studies suggesting a COVID-19 and BP, we were unable to clearly identify a relationship between COVID-19 and BP. Interestingly, all patients with facial paralysis and COVID-19 were unvaccinated. To further study this relationship, we recommend consideration of a COVID-19 test for any patient that presents with facial paralysis.

Simultaneous Sudden Hearing Loss and Peripheral Facial Paralysis in a Patient With Covid-19

Although peripheral facial paralysis and sudden sensorineural hearing loss are not as common as anosmia, they are reported neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a 62-year-old, serologically COVID-19 positive woman with seventh and eighth nerve involvement showed electrophysiologically with Auditory Brainstem Response and electroneurography and radiologically with internal acoustic canal magnetic resonance imaging. This single case report suggests a possible association between the SARS-CoV-2 infection with simultaneous sudden sensorineural hearing loss and isolated facial paralysis. However, further studies are needed to determine whether this relationship is coincidental or occasional.

Irreversible facial nerve palsy as a revelator ofparotid gland cancer

<br><b>Introduction:</b> Bell's palsy is still the diagnosis of exclusion. In most patients it does not progress, it is unilateral, and selflimiting. Additionally, the majority of patients recover spontaneously within 3 weeks. It is well known that all patients with irreversible facial nerve paresis (FNP) need further examinations to exclude the organic, infectious, metabolic, and autoimmunological causes of the palsy. The goal of the study was to assess the frequency of malignancies hidden under the diagnosis of "Bell's palsy".</br> <br><b>Aim:</b> We aimed to create a diagnostic algorithm to avoid failures concerning patients whose only symptom of parotid gland cancer was irreversible FNP.</br> <br><b>Material and methods:</b> We analyzed 253 consecutive patients with FNP treated in our department in the last 5 years. The subject of the study was "Bell's palsy" cases. All patients with irreversible FNP were reassessed in 6-12 months. We underlined all shortcomings in the diagnostics of those in whom malignancies were found in MRI of the neck and presented the proposal for a diagnostic algorithm to avoid missing such an entity.</br> <br><b>Results:</b> Bell's palsy was observed in 157/253 patients (62.06%), in 36/157 (22.92%) it remained permanent. In 4/36 patients (11.11%) with irreversible FNP, which constituted 2.54% of all "Bell's palsy" cases, parotid gland deep lobe mass was found in MRI. In one patient, infiltration of the skull base was diagnosed. Adenoid cystic carcinoma was confirmed in final histopathology in all cases.</br> <br><b>Conclusions:</b> Our experience has shown that irreversible FNP can be a revelator of the malignant tumor located in the deep lobe of the parotid gland. Contrast-enhanced MRI covering intra- and extracranial segments of the facial nerve should be ordered in all cases of FNP without recovery after 4 months. Repeated imaging should be considered in undiagnosed cases. The main point of our study is to underline that the assessment of the deep lobe of the parotid gland with MRI should be included in the standard diagnostic protocol in all irreversible "Bell's palsy" cases.</br>.

Treatment of idiopathic facial paralysis (Bell's Palsy) and secondary facial paralysis with extracellular vesicles: a pilot safety study

BACKGROUND

Paralysis of the facial nerve (CN VII) is one of the most debilitating issues that any patient can encounter. Bell's palsy is the most commonly seen mononeuropathy. Although usually self-limited, symptomatology can persist for decades in persistent cases. The non-surgical alternative therapies discussed in this study are successful without reconstruction and are regenerative.

OBJECTIVE AND DESIGN

We sought to determine a safe new treatment could be developed to restore facial nerve function using extracellular vesicles (EVs) in patients who have been unable to return to normal under a variety of conditions. We performed a pilot safety study of 7 patients with idiopathic and secondary facial paralysis to determine if any functional restoration was possible. Each patient had symptomology for varying periods of time, with diverse House-Brackmann scores. They were all treated with the same protocol of extracellular vesicles (EVs) over a 4-week period of time and were evaluated both before and after treatment.

CASE PRESENTATIONS

All patients in this study received treatment by their private physicians prior to entering the study. A record review was completed, with independent physical examinations. House-Brackmann scores and Facial Disability Indices were obtained prior to, and after completing the study. EVs were injected into the area of the main trunk of the facial nerve on the affected side, and an intravenous drip of EVs on visits during weeks 1, 2, and 4.

CONCLUSIONS

All seven patients enrolled in the study improved with this treatment protocol. After the second week of treatment, we saw a progression of independent motion of the affected eyelid, brow motion, and commissure. Although all patients began at different House-Brackman starting points, almost all ended at the same endpoint on the scale over the same period of time - four weeks. No adverse effects were encountered. Clearly, the duration of the treatment protocol needs to be longer than one month. The pathomechanism is still unknown. But it appears that the mechanism is reversible. At last, these patients can have hope.

TRIAL REGISTRATION

The Institute of Regenerative and Cellular Medicine IRB approval number: IRCM-2021-304.

Prevalence of self-perceived audiovestibular symptoms in Egyptian COVID-19 patients

BACKGROUND

According to National Institute for Health and Care Excellence (NICE), UK, common audiovestibular symptoms of COVID-19 include dizziness, tinnitus, and otalgia. The pathogenesis of otologic disorders ranges from direct damage to the inner ear structures to immune-mediated damage. Since the start of the pandemic, the prevalence of audiovestibular symptoms linked to COVID-19 has not been thoroughly investigated in Egypt. Our objective is to study and analyze the prevalence of the audiovestibular symptoms in the Egyptian population with history of COVID-19 infection.

METHODS

A cross-sectional study was conducted among Egyptian adults on the presence and nature of the audiovestibular manifestations in COVID-19 patients. An online questionnaire was used. The questionnaire was developed using Google Form. It was disseminated to the target population through social platforms from October 2021 till February 2022.

RESULTS

Data from 245 respondents were collected through online assessment of a convenient sample. The following de novo audiovestibular symptoms were experienced by the participants: Vertigo 20.8%, hearing loss 13.9%, tinnitus 12.7% and ear fullness 11.4%. No correlation was found between the investigations done (D-Dimer, CT chest) and the audiovestibular symptoms.

CONCLUSION

Audiovestibular symptoms are fairly common among COVID-19 patients, with higher prevalence, particularly of vertigo, in our study sample compared to the literature. It is recommended that patients with audiovestibular symptoms undergo early testing so that prompt interventions can be taken.

To explore the pathogenesis of Bell's palsy using diffusion tensor image

To explore the pathogenesis of Bell's palsy using the diffusion tensor image on 3.0 T MR. The healthy people and the patients with Bell's palsy underwent intraparotid facial nerve scanning by using the DTI and T1 structural sequence at 3.0 T MR. The raw DTI data were performed affine transformation and nonlinear registration in the common MNI152_T1 space and resampled to the 0.4 mm3 voxel size. A group of 4 spherical seed regions were placed on the intratemporal facial nerves in the common space, bilaterally and symmetrically. The DTI data in the common space were used to track the intratemporal facial nerve fibers by using TrackVis and its Diffusion Toolkit. Each tractography was used to construct the maximum probability map (MPM) according to the majority rule. The fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were calculated and extracted on the basis of MPM. For healthy people, there was no significant difference in FA, MD, RD and AD of bilateral facial nerves. For patients with Bell's palsy, there was no significant difference in AD, there was significant difference in FA, MD and RD between the affected nerve and the healthy nerve (P < 0.02). This study showed that the myelin sheath injury of the intratemporal facial nerve is the main cause of Bell's palsy. Most neural axons are not damaged. The results may explain the pathogenesis of the Bell's palsy, which is self-limited for most cases.