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Kwak MY, Lee HY, Lee SA, Jeong J, Chung JH, Kim J, Jun BC, Yeo SG, Kim SH, Lee JD. The Impact of the COVID-19 Pandemic on Bell's Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study. J Korean Med Sci 2024; 39:e140. [PMID: 38685888 PMCID: PMC11058340 DOI: 10.3346/jkms.2024.39.e140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This article presents a comprehensive review of data on the impact of facial palsy during the coronavirus disease 2019 (COVID-19) pandemic. The possible causes and pathophysiological mechanisms of changes in the epidemiology of facial palsy during the COVID-19 pandemic are also discussed. METHODS This multicenter retrospective cohort study included 943 patients diagnosed with Bell's palsy or Ramsay Hunt syndrome. This study compared patient demographics, comorbidities, symptoms, and treatments before the COVID-19 pandemic (from 2017 to 2019) and during the COVID-19 pandemic, from 2020 to 2022). RESULTS Following the COVID-19 outbreak, there has been a significant increase in the number of cases of Bell's palsy, particularly among elderly individuals with diabetes. Bell's palsy increased after the COVID-19 outbreak, rising from 75.3% in the pre-COVID-19 era to 83.6% after the COVID-19 outbreak. The complete recovery rate decreased from 88.2% to 73.9%, and the rate of recurrence increased from 2.9% to 7.5% in patients with Bell's palsy. Ramsay Hunt syndrome showed fewer changes in clinical outcomes. CONCLUSION This study highlights the impact of the COVID-19 pandemic on the presentation and management of facial palsy, and suggests potential associations with COVID-19. Notably, the observed increase in Bell's palsy cases among elderly individuals with diabetes emphasizes the impact of the pandemic. Identifying the epidemiological changes in facial palsy during the COVID-19 pandemic has important implications for assessing its etiology and pathological mechanisms of facial palsy disease.
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Affiliation(s)
- Min Young Kwak
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Ho Yun Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University Faculty of Medicine, Seoul, Korea
| | - Se A Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Junhui Jeong
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Ho Chung
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Kim
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Beom Cho Jun
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Geun Yeo
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Hoon Kim
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Jong Dae Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea.
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Imai T, Fujita Y. Zoster sine herpete of the trigeminal nerve revisited as a COVID-19-associated disease: Atypical manifestation of herpes zoster masquerading odontogenic symptoms. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101265. [PMID: 35987500 PMCID: PMC9385378 DOI: 10.1016/j.jormas.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Tomoaki Imai
- Department of Oral and Maxillofacial Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan.
| | - Yusei Fujita
- Department of Oral and Maxillofacial Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka, Japan
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Prevalence of herpes zoster virus reactivation in patients diagnosed with Bell's palsy. The Journal of Laryngology & Otology 2022; 136:975-978. [DOI: 10.1017/s0022215121004631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveHerpes zoster virus can cause inflammatory neuropathy of the facial nerve. However, studies evaluating the prevalence of this agent in peripheral facial palsy are heterogeneous regarding sample group selection, laboratory analysis method and variables studied. In addition, there are a lack of epidemiological data in the Brazilian population on this serological phenomenon in peripheral facial palsy. This study estimated herpes zoster reactivation prevalence in serological samples through chemiluminescence immunoassay for quantitative determination of specific antibodies directed against the virus.MethodsThis cross-sectional study sought to determine the prevalence of viral reactivation by herpes zoster in subjects with idiopathic peripheral facial palsy through analysis of serological samples over a year.ResultsForty-seven patients (32 females and 15 males) participated. Severe paralysis was more common in older patients (p = 0.017). Facial pain (p = 0.02) and vertigo (p = 0.001) were related to a worse evolution of facial palsy. The rate of serological reactivation of the virus was 12.76 per cent.ConclusionThe rate of serological reactivation of herpes virus in idiopathic peripheral facial palsy in our population is similar to foreign literature data, suggesting similar aetiological mechanisms in the genesis of this morbidity.
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Barsegian V, Kosova I. Zoster sine herpete causing voiding disorders in females. Scand J Urol 2022; 56:329-330. [DOI: 10.1080/21681805.2022.2096111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Vagan Barsegian
- Department of Urology and Surgical Andrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Inga Kosova
- Department of Urology and Surgical Andrology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
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Silva MR, Leite L, Sousa FP, Maré R, Pontes T. Ramsay Hunt's Syndrome in Pediatric Age. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1722618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractThe Ramsay Hunt's syndrome (RHS), caused by the reactivation of the varicella-zoster virus (VZV), is an infrequent cause of peripheral facial palsy in the pediatric patients. A 16-year-old adolescent boy presented with headache, right earache, and signs of lower motor neuron type facial palsy. He was medicated with deflazacort. Four days later, he developed blurry vision in the right eye, gait imbalance, and vesicular lesions in the right ear with decreased ipsilateral hearing acuity. A diagnosis of RHS was considered. Cerebrospinal fluid (CSF) analysis showed pleocytosis, as well as VZV DNA. Magnetic resonance imaging of the brain identified abnormal uptake of gadolinium contrast in the right seventh cranial nerve, reinforcing the diagnosis. The patient was treated with acyclovir (14 days) and prednisone, with progressive clinical improvement. We emphasize the importance of recognizing this syndrome in patients with facial palsy, since the early antiviral treatment significantly improves the prognosis.
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Affiliation(s)
| | - Lídia Leite
- Department of Pediatric Department, Hospital de Braga, Braga, Portugal
| | | | - Ricardo Maré
- Department of Neurology Department, Hospital de Braga, Braga, Portugal
| | - Teresa Pontes
- Department of Pediatric Department, Hospital de Braga, Braga, Portugal
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Kim SJ, Lee HY. Hematological Findings in Patients with Acute Peripheral Facial Palsy. J Int Adv Otol 2020; 16:382-386. [PMID: 33136021 DOI: 10.5152/iao.2020.8748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES This study aimed at evaluating the clinical significance of hematological findings in patients with acute peripheral facial palsy. MATERIALS AND METHODS For this retrospective case series review, 84 patients who visited our university hospital and were diagnosed with Bell's palsy (BP) or Ramsay Hunt syndrome (RHS) between March 2017 and March 2019 were enrolled. We documented their epidemiological details, final diagnoses, House-Brackmann (HB) palsy grades, and pretreatment and day 7 post-hospitalization complete blood counts. The outcome was considered favorable if the HB grade at weeks 10-16 was I or II. We analyzed the hematological findings in terms of diagnosis and the final treatment outcomes. RESULTS A higher pretreatment neutrophil-to-lymphocyte ratio (NLR) and neutrophil count and a lower day-7 lymphocyte count were observed in patients with RHS with unfavorable outcomes. In such patients, moderate positive correlations were observed between the pretreatment white blood cell, neutrophil, and basophil counts; the NLR and basophil-to-lymphocyte ratio; and the initial HB grade. Only the latter was a significant risk factor for a poor treatment outcome. In patients with BP, both the initial HB grade and the pretreatment eosinophil count were included in a regression model predicting prognosis. CONCLUSION Inflammation plays an important role in RHS pathogenesis. Initial RHS severity and the response to corticosteroids may determine the final treatment outcome. However, inflammatory markers do not predict all BP outcomes; BP may be etiologically heterogeneous.
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Affiliation(s)
- Su Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Non-idiopathic peripheral facial palsy: prognostic factors for outcome. Eur Arch Otorhinolaryngol 2020; 278:3227-3235. [PMID: 33025045 PMCID: PMC8328849 DOI: 10.1007/s00405-020-06398-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Objectives There is a lack of data on patients’ and diagnostic factors for prognostication of complete recovery in patients with non-idiopathic peripheral facial palsy (FP). Methods Cohort register-based study of 264 patients with non-idiopathic peripheral FP and uniform diagnostics and standardized treatment in a university hospital from 2007 to 2017 (47% female, median age: 57 years). Clinical data, facial grading, electrodiagnostics, motor function tests, non-motor function tests, and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics. Results The most frequent reason for a non-idiopathic peripheral FP was a reactivation of Varicella Zoster Virus (VZV; 36.4%). Traumatic origin had a higher proportion of complete FP (52.9%). Furthermore, in traumatic FP, the mean interval between onset and start of prednisolone therapy was longer than in other cases (5.6 ± 6.2 days). Patients with reactivation of VZV, Lyme disease or otogenic FP had a significant higher recovery rate (p = 0.002, p < 0.0001, p = 0.018, respectively), whereas patients with post-surgery FP and other reasons had a significant lower recovery rate (p < 0.0001). After multivariate analyses voluntary activity in first EMG, Lyme disease and post-surgery cause were identified as independent diagnostic and prognostic factors on the probability of complete recovery (all p < 0.05). Conclusion Infectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis. Level of evidence 2 Electronic supplementary material The online version of this article (10.1007/s00405-020-06398-6) contains supplementary material, which is available to authorized users.
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Corbacho-Zaldívar M, González-Sánchez E. Revisión sistemática sobre la prevalencia de la serología infecciosa en la parálisis facial periférica. REVISTA ORL 2020. [DOI: 10.14201/orl.23480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivos. La parálisis facial periférica es una afección del Nervio Facial que suele cursar con dolor retroauricular, pródromos vitales y parálisis facial. Ante la falta de bibliografía sobre la etiología de dicha parálisis se propuso realizar una revisión sistemática orientada a conocer la prevalencia serológica de la parálisis facial periférica en los diferentes estudios publicados incluyendo el realizado en esta facultad el curso anterior. Materiales y métodos. Revisión sistemática y metanálisis de los estudios publicados sobre la confirmación de una parálisis facial periférica por serología positiva. Resultados. Un total de 628 pacientes fueron analizados, de los cuáles 76 tenían serología positiva (12,10%). El metanálisis muestra heterogeneidad entre los resultados y sesgo de publicación. Conclusiones. No se evidencia que haya una relación significativa entre una parálisis facial periférica y una serología positiva reciente por lo que no se obtendría beneficio con un tratamiento antiviral.
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Ordoñez G, Vales O, Pineda B, Rodríguez K, Pane C, Sotelo J. The presence of herpes simplex-1 and varicella zoster viruses is not related with clinical outcome of Bell's Palsy. Virology 2020; 549:85-88. [PMID: 32858308 DOI: 10.1016/j.virol.2020.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/20/2020] [Accepted: 07/31/2020] [Indexed: 12/14/2022]
Abstract
Bell's Palsy is the most frequent acute neuropathy of cranial nerves; it has been associated in various reports to herpes viruses. In a prospective study we searched the presence of DNA from five herpes viruses (HSV-1 and 2, VZV, EBV and HHV-6) in 79 patients at the acute phase of Bell's Palsy. Results were related with various parameters; age, gender and clinical outcome. We found the significant presence (p˂0.001) of HSV-1 and VZV in 39% and 42% of patients. However, a large percentage of cases were negative. When comparisons were made between subgroups according to gender and age no differences were found with viral findings nor with clinical outcome of palsy, which was of clinical remission in most cases (78%). Our results suggest that herpes viruses might participate in the complex mechanisms of autoimmunity of Bell's Palsy but not as determinant etiological element.
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Affiliation(s)
- Graciela Ordoñez
- Neuroimmunology Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur 3877, Mexico City, 14269, Mexico
| | - Olivia Vales
- Department of Neuro-otology, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur 3877, Mexico City, 14269, Mexico
| | - Benjamín Pineda
- Neuroimmunology Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur 3877, Mexico City, 14269, Mexico
| | - Karla Rodríguez
- Neuroimmunology Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur 3877, Mexico City, 14269, Mexico
| | - Carlo Pane
- Department of Neuro-otology, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur 3877, Mexico City, 14269, Mexico
| | - Julio Sotelo
- Neuroimmunology Unit, National Institute of Neurology and Neurosurgery of Mexico, Insurgentes Sur 3877, Mexico City, 14269, Mexico.
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Kim SJ, Lee HY. Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature. J Korean Med Sci 2020; 35:e245. [PMID: 32743989 PMCID: PMC7402921 DOI: 10.3346/jkms.2020.35.e245] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest. METHODS An electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms "Bell's palsy," "Ramsay-Hunt syndrome," "Facial palsy," "Facial paralysis," "Facial paresis," "Guideline," "Meta-analysis," "Systematic review," and "Randomized controlled trial." Only studies written in English were used. RESULTS The characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised. CONCLUSION For peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.
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Affiliation(s)
- Su Jin Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Ho Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, Ewha Womans University School of Medicine, Seoul, Korea.
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Zhou J, Li J, Ma L, Cao S. Zoster sine herpete: a review. Korean J Pain 2020; 33:208-215. [PMID: 32606265 PMCID: PMC7336347 DOI: 10.3344/kjp.2020.33.3.208] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/30/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
Zoster sine herpete (ZSH) is one of the atypical clinical manifestations of herpes zoster (HZ), which stems from infection and reactivation of the varicella-zoster virus (VZV) in the cranial nerve, spinal nerve, viscera, or autonomic nerve. Patients with ZSH display variable symptoms, such as neuralgia, however, different from HZ, ZSH show no zoster, which makes clinical diagnosis difficult. ZSH not only causes initial symptoms, such as neuropathic pain in the affected nerve, Bell palsy, and Ramsay Hunt syndrome, but also postherpetic neuralgia and fatal complications such as VZV encephalitis and stroke. The misdiagnosis of ZSH and tardy antiviral treatment may lead to severe ZSH sequelae. We review the publications related to ZSH, especially its diagnosis with VZV DNA and/or anti-VZV immunoglobulin (IgG and IgM). More work about ZSH, especially ZSH epidemiological survey and guidelines for its diagnosis and treatment, are needed because most of the present studies are case reports.
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Affiliation(s)
- Junli Zhou
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Juan Li
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lulin Ma
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Song Cao
- Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China
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Ramirez-Salas JE, Benito-Orejas JI, Bauer M, Viveros-Díez P, Cifuentes-Navas VA, Duque-Holguera V. Manifestaciones clínicas del síndrome de Ramsay-Hunt en una serie de 20 casos. REVISTA ORL 2020. [DOI: 10.14201/orl.22750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción y objetivo: la experiencia clínica nos ha mostrado las distintas formas de presentación y la variabilidad sintomatológica que puede revelar el síndrome de Ramsay-Hunt o herpes zóster ótico. Las descripciones que ofrece la literatura nos han servido para corroborar los hallazgos de un conjunto de pacientes, cuyas características y evolución hemos ido reuniendo en el tiempo. Dada la importancia del tratamiento precoz, el objetivo de este trabajo ha consistido en realizar una exposición estructurada de este complejo síndrome con sus diversas manifestaciones. Método: estudio retrospectivo. Resultados: 20 pacientes ejemplifican los diferentes aspectos de este proceso. Discusión: se trata de una patología infrecuente, con una tríada sintomática patognomónica que consiste en otalgia, erupción vesicular y parálisis facial. Sin embargo, este síndrome no siempre se expresa de forma completa ni con la aparición de los síntomas en el orden indicado, añadiéndose con frecuencia otros cocleovestibulares. La posibilidad de que la infección se propague de forma centrífuga y centrípeta facilita el que se afecten otros nervios sensitivos y motores, ocasionando una polineuropatía craneal (herpes zóster cefálico) y raquídea o incluso, con mucha menor frecuencia, la aparición de una meningoencefalitis. No conocemos con precisión los mecanismos por los que progresa este proceso ni los factores desencadenantes, aunque en ocasiones les haya predisponentes. Establecer un diagnóstico es fundamental para iniciar el tratamiento, cuya precocidad facilita la resolución del proceso. Conclusiones: siendo la sospecha clínica la principal herramienta de un diagnóstico precoz, nos ha parecido de interés realizar esta revisión, dada la infrecuencia del herpes zóster ótico.
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Atypical clinical manifestations of herpes zoster oticus: diagnostic usefulness of magnetic resonance imaging. J Neurovirol 2019; 25:874-882. [PMID: 31278535 DOI: 10.1007/s13365-019-00781-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Typical symptoms of Ramsay Hunt syndrome (RHS) consist of painful vesicular eruptions in the external ear, unilateral facial palsy, and/or vestibulocochlear deficit. When RHS patients show atypical clinical manifestations, correct diagnosis can be delayed, and ideal treatment timing for antiviral therapy may be missed. The aim of this study is to describe RHS patients with atypical clinical manifestations and evaluate the usefulness of magnetic resonance imaging (MRI) for early differential diagnosis. We retrospectively reviewed the clinical data and investigated the findings of internal auditory canal (IAC) MRI of seven patients diagnosed with RHS presenting "atypical" clinical manifestations between January 2013 and December 2016. "Typical" symptoms of RHS consist of herpetic vesicular eruption and facial palsy with or without vestibulocochlear deficit. Regardless of symptomatic presentations, IAC MRI demonstrated post-contrast enhancement of cranial nerve (CN) VII, CN VIII, and IAC dura in patients with atypical clinical manifestations. In cases with multiple lower CN palsy, enhancement along the involved nerve was observed on IAC MRI. When RHS was complicated by acute parotiditis, diffuse enhancement of the parotid gland was demonstrated. The present study shows that in IAC MRI of RHS patients with atypical clinical manifestations, post-contrast enhancement was not confined to the facial nerve but also observed in CN VIII and IAC dura regardless of the symptoms, which may facilitate early diagnosis of RHS.
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Wei S, Li X, Wang H, Liu Q, Shao L. Analysis of the Risk Factors for Postherpetic Neuralgia. Dermatology 2019; 235:426-433. [DOI: 10.1159/000500482] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/18/2019] [Indexed: 11/19/2022] Open
Abstract
Background: Postherpetic neuralgia is the most common complication of herpes zoster, affecting 30% of patients. It seriously affects the quality of life of patients and the curative effect of treatment is limited. So far, researchers do not fully understand the risk factors for postherpetic neuralgia and more research is needed. Objective: The aim of this paper was to investigate the risk factors for postherpetic neuralgia and provide reference for clinical diagnosis and treatment. Methods: A total of 202 inpatients with herpes zoster in the General Hospital of Tianjin Medical University were recruited as study subjects. According to the occurrence of postherpetic neuralgia, the patients were divided into the postherpetic neuralgia group and the nonpostherpetic neuralgia group. Data on age, gender, initial symptoms, clinical classification, involved nerves, pain grading, antiviral therapy, glucocorticoid use, and other clinical data of patients in the two groups were collected and statistically analyzed. Univariate and multivariate analysis methods were used to analyze the differences between the two groups and determine the influencing factors of postherpetic neuralgia. Results: The univariate statistical analysis of the factors influencing postherpetic neuralgia showed that the contribution of gender, initial symptoms, general clinical classification, use of glucocorticoid, and the interval from onset to antiviral therapy were not statistically significant, while the differences in age, specific clinical classification, involved nerves, severity of pain during the acute stage, and body side of skin lesion distribution were statistically significant. Multivariate logistic regression analysis showed that gender, use of glucocorticoid, interval from onset to antiviral therapy, involved nerves, and specific clinical classification showed no statistical significance. However, there were significant differences in age, body side of skin lesion distribution, general clinical classification, and degree of pain during the acute stage of the disease. Conclusion: Pain during the acute stage of herpes zoster, age greater than 70 years, and serious type of skin lesion are risk factors for postherpetic neuralgia (p < 0.05, OR >1).
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Drago F, Herzum A, Ciccarese G, Broccolo F, Rebora A, Parodi A. Acute pain and postherpetic neuralgia related to Varicella zoster virus reactivation: Comparison between typical herpes zoster and zoster sine herpete. J Med Virol 2018; 91:287-295. [PMID: 30179265 DOI: 10.1002/jmv.25304] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/17/2018] [Indexed: 12/11/2022]
Abstract
Herpes zoster (HZ) is typically characterized by pain involving the area of vesicular eruption. Several patients, however, complain of unilateral radicular pain without rash (zoster sine herpete [ZSH]). To evaluate whether the severity and duration of pain and the use of analgesics are greater in ZSH patients than in typical HZ with rash, 16 consecutive patients with acute unilateral pain, without vesicular eruption (ZSH), were compared with 16 controls suffering from typical HZ eruption. Only patients with laboratory evidence of varicella-zoster virus (VZV) reactivation were selected. Serum samples were obtained from all patients at their initial visit and 1 and 2 months later. Monthly, the administered therapies and the average pain score (visual analog scale [VAS] score) were recorded. VZV DNA persisted statistically higher in ZSH sera than HZ sera 1 month after onset (P = 0.0007). ZSH patients averaged greater pain than HZ patients, scoring VAS 76.88 and 66.88 ( P = 0.0012), respectively. ZSH patients used significantly more opioid therapy than HZ patients ( P = 0.0449; OR, 9.00). This is the first study comparing pain in ZSH and HZ patients: greater severity and duration of pain and more opioid use was detected in patients with ZSH.
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Affiliation(s)
- Francesco Drago
- DISSAL Section of Dermatology, Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Astrid Herzum
- DISSAL Section of Dermatology, Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Giulia Ciccarese
- DISSAL Section of Dermatology, Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Francesco Broccolo
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Alfredo Rebora
- DISSAL Section of Dermatology, Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
| | - Aurora Parodi
- DISSAL Section of Dermatology, Policlinico San Martino, Largo Rosanna Benzi, Genoa, Italy
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16
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Song K, Chang S, Lee J, Shin SA, Lee HY. Clinical Characteristics of Dizziness Associated with Acute Peripheral Facial Palsy. J Audiol Otol 2018; 22:148-153. [PMID: 29656635 PMCID: PMC6103497 DOI: 10.7874/jao.2017.00374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/02/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives We aimed to assess the clinical significance of dizziness associated with acute peripheral facial palsy (APFP). Subjects and Methods Medical records of patients who visited an otorhinolaryngology clinic at a university hospital and were admitted for treatment of APFP between 2014 and 2016 were thoroughly reviewed. Results In total, 15.3% (n=15) of patients had dizziness. Continuous, rotatory dizziness without exacerbating factors was most common and frequently accompanied by nausea/vomiting. Dizziness disappeared within 1 week during the hospitalization period. Patients with Ramsay Hunt syndrome (31.0%) had dizziness more frequently than those with Bell’s palsy (8.7%). In addition, higher hearing thresholds and pain around the ear was reported more often in dizzy patients (p<0.05). Logistic regression analysis revealed that the initial House-Brackmann grade of facial paralysis was solely associated with final recovery, but dizziness was not associated with prognosis. Conclusions Patients with APFP may have transient dizziness in the early stage, which may be more frequently accompanied by worse hearing thresholds and/or pain around the ear. However, these symptoms including dizziness seem to be unrelated to final prognosis.
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Affiliation(s)
- Kudamo Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Sehun Chang
- Department of Neurosurgery, Eulji University School of Medicine, Daejeon, Korea
| | - Jun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Sun Ae Shin
- Department of Medical Science, Chungnam National University, Daejeon, Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji University School of Medicine, Daejeon, Korea
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17
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Chang DS, Lee J, Shin SA, Lee HY. Characteristics of patients with acute peripheral facial palsy showing
Varicella zoster virus
DNA in saliva. J Med Virol 2018; 90:959-964. [DOI: 10.1002/jmv.25030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Dong Sik Chang
- Department of OtorhinolaryngologyEulji University HospitalEulji UniversityDaejeonRepublic of Korea
| | - Jun Lee
- Department of OtorhinolaryngologyEulji University HospitalEulji UniversityDaejeonRepublic of Korea
| | - Sun Ae Shin
- Department of Medical ScienceChungnam National UniversityDaejeonKorea
| | - Ho Yun Lee
- Department of OtorhinolaryngologyEulji University HospitalEulji UniversityDaejeonRepublic of Korea
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18
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Comparison of Treatment Outcomes Following Either Prefrontal Cortical-only or Dual-site Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus Patients: A Double-blind Randomized Study. Otol Neurotol 2017; 40:e1024-e1029. [PMID: 28068305 DOI: 10.1097/mao.0000000000001266] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We evaluated treatment outcomes following single-site repetitive transcranial magnetic stimulation (rTMS) in the dorsolateral prefrontal cortex (DLPFC) and dual-site rTMS in the auditory cortex (AC) and DLPFC (AC + FC). STUDY DESIGN AND PATIENTS This prospective randomized double-blind trial initially included 19 patients with chronic tinnitus and 17 of these patients received rTMS on the left AC and left DLPFC or only the left DLPFC. The subjects were randomly allocated to either the dual-site rTMS (AC + FC) protocol (Group 1, n = 9) or the singlesite rTMS (DLPFC) protocol (Group 2, n = 8). Group 1 received daily treatments with 2,000 pulses applied to the AC and 1,000 pulses applied to the DLPFC for 4 days (total of 12,000 pulses) and Group 2 received daily treatments with 3,000 pulses applied the DLPFC for 4 days (total of 12,000 pulses). MAIN OUTCOME MEASURES The severity of tinnitus was assessed before rTMS treatment using the Tinnitus Handicap Inventory (THI) and the self-rated Visual Analog Scale. These measures were used to determine the awareness, loudness, annoyance, and effects of tinnitus on daily life at 1, 2, 4, and 12 weeks after treatment. RESULTS The improvement in THI score was significantly better in Group 1 than in Group 2, even after controlling for the between-group differences in pretreatment THI score. In terms of psychological factors, Group 1 exhibited significant improvements in scores on the State-Trait Anxiety Inventory (STAI) for both state anxiety (STAI-X1) and trait anxiety (STAI-X2) at 12 weeks posttreatment and scores on the Pittsburgh Sleep Quality Index at 4 weeks posttreatment. Group 2 showed an improvement in only the STAI-X2 score at 12 weeks posttreatment. CONCLUSIONS The rTMS protocol effectively suppressed tinnitus in the dual-site rTMS (AC+FC) group but not in the single-site rTMS (DLPFC) group. Although recent evidence has shown that non-auditory cortices in the tinnitus network play an important role in the generation of tinnitus, our findings indicate that rTMS on non-auditory cortical sites alone may not be sufficient for treatment. Thus, dual-site rTMS in the AC and DLPFC may be preferable for controlling this condition.
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Lindström J, Grahn A, Zetterberg H, Studahl M. Cerebrospinal fluid viral load and biomarkers of neuronal and glial cells in Ramsay Hunt syndrome. Eur J Neurosci 2016; 44:2944-2949. [PMID: 27643680 DOI: 10.1111/ejn.13403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 08/31/2016] [Accepted: 09/13/2016] [Indexed: 11/29/2022]
Abstract
Reactivation of varicella zoster virus (VZV) can manifest with facial palsy diagnosed as Ramsay Hunt Syndrome (RHS) or Ramsay Hunt Syndrome zoster sine herpete (RHS-ZSH). These syndromes are associated with poor prognosis despite treatment with antivirals and corticosteroids. Concentrations of biomarkers such as neurofilament protein (NFL), S-100β protein and glial fibrillary acidic protein (GFAp) have previously been measured in cerebrospinal fluid (CSF) to assess neuronal damage and glial pathology. We employed immunochemical methods to measure concentrations of NFL, S-100β protein and GFAp in CSF from patients with RHS (n = 15) and RHS-ZSH (n = 13) diagnosed by detection of VZV DNA in the CSF by quantitative PCR, and compared with a control group (n = 52). The biomarker concentrations were correlated with CSF viral load and outcome measured by House-Brackmann score. NFL and GFAp concentrations were increased compared with controls (P = 0.008 and P = 0.04), while S-100β levels were decreased. This pattern was more pronounced in patients with RHS compared to the patients with RHS-ZSH (NS and P = 0.028). The amount of viral DNA in CSF correlated with increased GFAp (P = 0.003) and NFL (P = 0.006). No correlations were found between biomarker concentrations and patient outcome. Patients with facial palsy caused by VZV had biochemical signs of neuronal damage and astrogliosis. High amounts of viral DNA may be associated with the degree of damage on neuronal and astroglial cells. Prospective studies are warranted to elucidate the association of elevated biomarkers in the CSF and outcome assessed by more sensitive tests.
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Affiliation(s)
- Johan Lindström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 21, Gothenburg, SE-416 85, Sweden
| | - Anna Grahn
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 21, Gothenburg, SE-416 85, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Marie Studahl
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Diagnosvägen 21, Gothenburg, SE-416 85, Sweden
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20
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Wasano K, Kawasaki T, Yamamoto S, Tomisato S, Shinden S, Ishikawa T, Minami S, Wakabayashi T, Ogawa K. Pretreatment Hematologic Findings as Novel Predictive Markers for Facial Palsy Prognosis. Otolaryngol Head Neck Surg 2016; 155:581-7. [PMID: 27165675 DOI: 10.1177/0194599816646552] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the relationship between prognosis of 2 different facial palsies and pretreatment hematologic laboratory values. STUDY DESIGN Multicenter case series with chart review. SETTING Three tertiary care hospitals. SUBJECTS AND METHODS We examined the clinical records of 468 facial palsy patients who were treated with an antiviral drug in combination with either oral or intravenous corticosteroids in participating hospitals between 2010 and 2014. Patients were divided into a Bell's palsy group or a Hunt's palsy group. We used the Yanagihara facial nerve grading system to grade the severity of facial palsy. "Recovery" from facial palsy was defined as achieving a Yanagihara score ≥36 points within 6 months of onset and having no accompanying facial contracture or synkinesis. We collected information about pretreatment hematologic findings, demographic data, and electrophysiologic test results of the Bell and Hunt group patients who recovered and those who did not. We then compared these data across the 2 palsy groups. RESULTS In the Bell's palsy group, recovered and unrecovered patients differed significantly in age, sex, electroneuronography score, stapedial muscle reflex, neutrophil rate, lymphocyte rate, neutrophil-to-lymphocyte ratio, and initial Yanagihara score. In the Hunt's palsy group, recovered and unrecovered patients differed in age, electroneuronography score, stapedial muscle reflex, monocyte rate, platelet count, mean corpuscular volume, and initial Yanagihara score. CONCLUSIONS Pretreatment hematologic findings, which reflect the severity of inflammation and bone marrow dysfunction caused by a virus infection, are useful for predicting the prognosis of facial palsy.
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Affiliation(s)
- Koichiro Wasano
- Department of Otolaryngology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taiji Kawasaki
- Department of Otolaryngology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Sayuri Yamamoto
- Department of Otolaryngology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Shuta Tomisato
- Department of Otolaryngology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Seiichi Shinden
- Department of Otolaryngology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Toru Ishikawa
- Department of Otolaryngology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Shujiro Minami
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takeshi Wakabayashi
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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21
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Park H. Diverse clinical manifestations caused by varicella-zoster virus reactivation. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hosun Park
- Department of Microbiology, College of Medicine, Yeungnam University, Daegu, Korea
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22
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Zhao Y, Feng G, Gao Z. Advances in diagnosis and non-surgical treatment of Bell's palsy. J Otol 2015; 10:7-12. [PMID: 29937775 PMCID: PMC6002555 DOI: 10.1016/j.joto.2015.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 02/16/2015] [Accepted: 02/23/2015] [Indexed: 11/24/2022] Open
Abstract
Bell's palsy is a commonly seen cranial nerve disease and can result in compromised facial appearance and functions. Its etiology, prognosis and treatment are still being debated. This paper is a review of recent development in the understanding of etiology, diagnosis and non-surgical treatment of Bell's palsy.
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Affiliation(s)
| | | | - Zhiqiang Gao
- Department of Otolaryngology, Peking Union Medical College Hospital, China Medical Science Academy, Beijing, 100730, China
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23
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A Case of Associated Laryngeal Paralysis Caused by Varicella Zoster Virus without Eruption. Case Rep Med 2014; 2014:916265. [PMID: 24715925 PMCID: PMC3970333 DOI: 10.1155/2014/916265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/11/2014] [Indexed: 11/23/2022] Open
Abstract
We report a patient with significant weakness of the left soft palate, paralysis of the left vocal cord, and left facial nerve palsy. Although the patient showed no herpetic eruption in the pharyngolaryngeal mucosa and auricle skin, reactivation of varicella zoster virus (VZV) was confirmed by serological examination. She was diagnosed with zoster sine herpete. After treatment with antiviral drugs and corticosteroids, her neurological disorder improved completely. When we encounter a patient with associated laryngeal paralysis, we should consider the possibility of reactivation of VZV even when no typical herpetic eruption is observed.
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24
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Lee HY, Yeo SG. The reply. Am J Med 2013; 126:e29. [PMID: 24262738 DOI: 10.1016/j.amjmed.2013.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 07/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ho Yun Lee
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, Korea
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