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Fujiwara T, Hato N, Kasahara T, Kasuya D, Shida K, Tanabe M, Nakano H, Haginomori SI, Hamada M, Hayashi A, Furuta Y, Matsuda K, Morishima N, Yamada T, Nakagawa T. Summary of Japanese clinical practice guidelines for Bell's palsy (idiopathic facial palsy) - 2023 update edited by the Japan Society of Facial Nerve Research. Auris Nasus Larynx 2024; 51:840-845. [PMID: 39079445 DOI: 10.1016/j.anl.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/23/2024] [Accepted: 07/07/2024] [Indexed: 09/14/2024]
Abstract
OBJECTIVE The "Summary of Japanese clinical practice guidelines for Bell's palsy (idiopathic facial palsy) - 2023 update edited by the Japan Society of Facial Nerve Research" aims to review the latest evidence regarding the treatment of Bell's palsy and to provide appropriate recommendations. METHOD Regarding the treatment of Bell's palsy, a guideline panel identified key clinical questions using an analytic PICO framework. The panel produced recommendations following the standards for trustworthy guidelines and the GRADE approach. The panel considered the balance of benefits, harm, and preferences when making recommendations. RESULTS The panel identified nine key clinical questions: systemic (high/standard dose) corticosteroids, intratympanic corticosteroids, systemic antivirals, decompression surgery, acupuncture, physical therapy, botulinum toxin, and reanimation surgery. CONCLUSION These guidelines strongly recommend systemic standard-dose corticosteroids for the clinical management of Bell's palsy. Other treatments are weakly recommended due to insufficient evidence. The absolute risk reduction of each treatment differed according to the disease severity. Therefore, physicians and patients should decide on treatment based on the disease severity.
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Affiliation(s)
- Takashi Fujiwara
- Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital. 1-1-1 Miwa, Kurashiki City, Okayama Prefecture, 710-8602, Japan.
| | - Naohito Hato
- Department of Molecular and Cellular Physiology, Graduate School of Medicine, Ehime University. Shizukawa 454, Toon city, Ehime Prefecture, 791-0295 Japan
| | - Takashi Kasahara
- Department of Rehabilitation Medicine, Tokai University School of Medicine. 143, Shimokasuya, Isehara, Kanagawa Prefecture, 259-1193, Japan
| | - Daichi Kasuya
- Department of Acupuncture Health, Niigata University of Health and Welfare. 1398 Shimami-cho, Kita-ku, Niigata city, Niigata Prefecture, 950-3198, Japan
| | - Kenji Shida
- Department of Anesthesiology, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-Chuo, Tsuzuki-Ku, Yokohama city, Kanagawa Prefecture, 224-8503, Japan
| | - Makito Tanabe
- Oiki Ear & Nose Surgicenter. Yayoi-cho 2-14-13, Izumi city, Osaka, Japan
| | - Haruki Nakano
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University, Daigakumachi 2-7, Takatsuki city, Osaka, Japan
| | - Shin-Ichi Haginomori
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka Medical and Pharmaceutical University. Takatsuki city, Osaka Prefecture, 569-8686, Japan
| | - Masashi Hamada
- Department of Otolaryngology and Head and Neck Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa Prefecture, 259-1193, Japan
| | - Ayato Hayashi
- Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital. 3-9 Fukuura, Kanazawa-ku, Yokohama city, Kanagawa Prefecture, 236-0004, Japan
| | - Yasushi Furuta
- Department of Otolaryngology-Head and Neck Surgery, Teine-Keijinkai Hospital. 1-12, Maeda, Teine-ku, Sapporo, 006-8555, Japan
| | - Ken Matsuda
- Department of Plastic and Reconstructive Surgery, Niigata University Graduate School of Medicine. 1-757, Asahimachi-Dori, Chuo-ku, Niigata city, Niigata Prefecture, 951-8510, Japan
| | - Naohito Morishima
- Department of Rehabilitation, Toyohashi Municipal Hospital. 50 Hachikennishi, Aotake-cho, Toyohashi city, Aichi Prefecture, 441-8570, Japan
| | - Takechiyo Yamada
- Department of Otorhinolaryngology, Head and Neck Surgery, Akita University, Graduate School of Medicine, Akita, 010-8543, Japan
| | - Takashi Nakagawa
- Department of Otorhinolaryngology, Graduate School of Medical Sciences Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582 Japan
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Leonetti JP, Shukairy MK, North M, Foecking E, Burkman L. A New Surgical Option For Patients with Unresolved Bell's Palsy. Curr Neurol Neurosci Rep 2024; 24:381-387. [PMID: 39046641 DOI: 10.1007/s11910-024-01358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE This paper describes a new surgical procedure with electrical stimulation of the facial nerve for unresolved Bell's palsy and compares the facial nerve recovery with another group who underwent traditional middle cranial fossa decompression. RECENT FINDINGS All patients with total unilateral facial paralysis had surgery by the senior author 3 months from onset of Bell's Palsy. Surgical decompression was performed in 13 patients between 1992-2012 (Group 1). Surgical exposure with intraoperative electrical stimulation of the facial nerve in the peri-geniculate region was performed in 47 patients between 2012-2022 (Group 2). The facial recovery at 1 month and 3 month were significantly better in Group 2. The degree of synkinesis was significantly less in Group 2. The trans-mastoid electrical stimulation of the facial nerve is less invasive, requires no hospital stay, and less time off work compared to the middle cranial fossa approach. The earlier facial movement at one month results in less long-term unwanted faulty regeneration or synkinesis.
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Affiliation(s)
- John P Leonetti
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Health System, 2160 S. First Avenue, Maywood, IL, 60153, USA.
| | - M Kareem Shukairy
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Health System, 2160 S. First Avenue, Maywood, IL, 60153, USA
| | - Monique North
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Eileen Foecking
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Health System, 2160 S. First Avenue, Maywood, IL, 60153, USA
- Molecular Pharmacology and Neuroscience, Loyola University Health System, Maywood, IL, USA
| | - Lisa Burkman
- Department of Physical Therapy, Loyola University Health System, Maywood, IL, USA
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Gülüstan F, Yazıcı ZM, Koç RH, İnan BK, Aşaroğlu CB, Sayın İ. Delayed-onset facial paralysis following cochlear implantation: a case study and comprehensive analysis. Cochlear Implants Int 2024:1-4. [PMID: 38970817 DOI: 10.1080/14670100.2024.2370685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2024]
Abstract
OBJECTIVES Cochlear implantation (CI) is a surgical intervention used to rehabilitate hearing in individuals, both pediatric and adult, with severe hearing loss. It is generally a safe procedure with rare postoperative complications. Facial nerve paralysis following cochlear implant surgery poses challenges in diagnosis and treatment. METHODS This case report details a 48-year-old male who experienced delayed facial paralysis after cochlear implantation, an uncommon occurrence with limited documentation. RESULTS The facial nerve palsy of the patient resolved by the third week with combined therapy. DISCUSSION The etiology of this complication is not fully understood, with latent virus reactivation, particularly HSV and VZV, hypothesized as a probable cause. CONCLUSION Successful management involves a combination of corticosteroids, antiviral therapy, and antibiotics, leading to a favorable outcome.
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Affiliation(s)
- Filiz Gülüstan
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
| | - Zahide Mine Yazıcı
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
| | - Recep Haydar Koç
- Department of Otorhinolaryngology & Head and Neck Surgery, Sultangazi Haseki Training and Research Hospital, Istanbul 34260, Turkey
| | - Burak Kaan İnan
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
| | - Can Berk Aşaroğlu
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
| | - İbrahim Sayın
- Department of Otorhinolaryngology & Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Zuhuratbaba, Dr. Tevfik Sağlam Street, 11, Istanbul 34147, Turkey
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Ohm R, Stark B, Brännström F, Marsk E. Sequelae Treatment Needs Following Peripheral Facial Palsy: Retrospective Analysis of 525 Patients. Otol Neurotol 2024; 45:e450-e456. [PMID: 38509809 DOI: 10.1097/mao.0000000000004162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This study uses retrospective longitudinal data from a large unselected cohort of patients with peripheral facial paralysis to determine the prevalence and patient characteristic predictors of sequelae receiving intervention. STUDY DESIGN Retrospective case review. SETTING Karolinska University Hospital in Stockholm Sweden serves as the only tertiary facial palsy center in the region. Here, patients are diagnosed, are followed up, and undergo all major interventions. PATIENTS All adult patients presenting with peripheral facial palsy due to idiopathic, zoster, or Borrelia origin at Karolinska, January 1, 2010 to December 31, 2011 with follow-up until December 2022. INTERVENTIONS Patient charts were studied to identify patient characteristics, etiology, initial treatment, severity of palsy, and treatments targeting sequelae. MAIN OUTCOME MEASURES Types of initial and late treatments were noted. Sunnybrook and/or House-Brackmann scales were used for palsy grading. RESULTS Five hundred twenty-five patients were included. Thirty-three patients (6.3%) received botulinum toxin injections and/or surgical treatment. In this subgroup, 67% received corticosteroids compared to 85% of all patients ( p = 0.005), cardiovascular disease prevalence was higher (23 and 42%, respectively, p = 0.009). For 81 patients (15%), follow-up was discontinued although the last measurement was Sunnybrook less than 70 or House-Brackmann 3 to 6. CONCLUSIONS Of patients with peripheral facial palsy, 6.3% underwent injections and/or surgical treatment within 12 years. However, due to a rather large proportion not presenting for follow-up, this might be an underestimation. Patients receiving late injections and/or surgical treatment had more comorbidities and received corticosteroid treatment to a significantly lower extent in the acute phase of disease.
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Affiliation(s)
- Rebecka Ohm
- Department of Otorhinolaryngology, Karolinska University Hospital, CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Birgit Stark
- Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | | | - Elin Marsk
- Department of Otorhinolaryngology, Karolinska University Hospital, CLINTEC, Karolinska Institute, Stockholm, Sweden
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Melhem AM, Leshgold N, Pokress H, Younan RA, Haddad M, Kantar RS, Azizzadeh B. Etiology and Management of 800 Patients With Facial Palsy at a Private Practice Setting Over a 5-Year Period. J Craniofac Surg 2024:00001665-990000000-01640. [PMID: 38810236 DOI: 10.1097/scs.0000000000010317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 04/15/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Very few papers investigated the etiologic breakdown and demographic characteristics of patients with facial nerve (FN) palsy. Our paper aims to present the etiologic breakdown and demographic characteristics of patients with FN palsy, presenting at a private care center between 2014 and 2019, along with the treatment modalities that were offered to them. METHODS Charts of 800 patients with facial palsy (FP) were reviewed. Data included the etiology of their diagnosis, family history, recurrent FP, demographic information, and treatment provided before and after presentation. RESULTS Seventy-five percent of our study population were females. The average period between diagnosis with FP and presentation at our center was 10.8 years. The most commonly identified etiology was Bell's palsy, followed by acoustic neuroma. Eighty-one percent of the study subjects were prescribed steroids and/or antivirals. Facial neuromuscular retraining, electrical stimulation, chemodenervation, and surgical intervention were also part of some treatment plans for our population. DISCUSSION Recommendations for the treatment of idiopathic FP include steroids with adjuvant antiviral medications. Data remains uncertain whether the combination therapy of steroids and antivirals has better results compared to steroids alone. Electrical stimulation is still a controversial therapeutic tool for facial paralysis with a potential role in exacerbating synkinesis. The difference in referral patterns between tertiary and private care centers can explain the disparity in the ranking of the etiologies between our study and what has been published. CONCLUSION Management of FP is a complex process. The FN community must develop a common database to improve its understanding of the different presentations.
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Affiliation(s)
- Antonio M Melhem
- Global Smile Foundation, Norwood, MA
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Wyckoff Heights Medical Center, Brooklyn
| | - Nicole Leshgold
- Department of Global Health, University of Washington, Seattle, WA
| | | | - Robert A Younan
- Global Smile Foundation, Norwood, MA
- Department of Plastics Surgery, Augusta University Medical Center, Augusta, GA
| | - Mario Haddad
- Global Smile Foundation, Norwood, MA
- Department of Plastics & Reconstructive Surgery, University of California-Irvine, Irvine, CA
- Department of Plastics Surgery, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ
| | - Rami S Kantar
- Global Smile Foundation, Norwood, MA
- The Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York City, NY
| | - Babak Azizzadeh
- Global Smile Foundation, Norwood, MA
- Department of Plastics Surgery, Cedars-Sinai Health System
- Department of Plastics Surgery, David Geffen School of Medicine, UCLA, Los Angeles
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Pauna HF, Silva VAR, Lavinsky J, Hyppolito MA, Vianna MF, Gouveia MDCL, Monsanto RDC, Polanski JF, Silva MNLD, Soares VYR, Sampaio ALL, Zanini RVR, Abrahão NM, Guimarães GC, Chone CT, Castilho AM. Task force of the Brazilian Society of Otology - evaluation and management of peripheral facial palsy. Braz J Otorhinolaryngol 2024; 90:101374. [PMID: 38377729 PMCID: PMC10884764 DOI: 10.1016/j.bjorl.2023.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 02/22/2024] Open
Abstract
OBJECTIVE To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.
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Affiliation(s)
- Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | | | | | - José Fernando Polanski
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Maurício Noschang Lopes da Silva
- Hospital de Clínicas de Porto Alegre (UFRGS), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil
| | - Vítor Yamashiro Rocha Soares
- Hospital Flávio Santos and Hospital Getúlio Vargas, Grupo de Otologia e Base Lateral do Crânio, Teresina, PI, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Raul Vitor Rossi Zanini
- Hospital Israelita Albert Einstein, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nicolau M Abrahão
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Guilherme Correa Guimarães
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
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Babl FE, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Oakley E, Wilson CL, Hopper SM, Cheek JA, Hearps S, Mackay MT, Dalziel SR, Lee KJ. Facial Function in Bell Palsy in a Cohort of Children Randomized to Prednisolone or Placebo 12 Months After Diagnosis. Pediatr Neurol 2024; 153:44-47. [PMID: 38320457 DOI: 10.1016/j.pediatrneurol.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Information on the medium-term recovery of children with Bell palsy or acute idiopathic lower motor neuron facial paralysis is limited. METHODS We followed up children aged 6 months to <18 years with Bell palsy for 12 months after completion of a randomized trial on the use of prednisolone. We assessed facial function using the clinician-administered House-Brackmann scale and the modified parent-administered House-Brackmann scale. RESULTS One hundred eighty-seven children were randomized to prednisolone (n = 93) or placebo (n = 94). At six months, the proportion of patients who had recovered facial function based on the clinician-administered House-Brackmann scale was 98% (n = 78 of 80) in the prednisolone group and 93% (n = 76 of 82) in the placebo group. The proportion of patients who had recovered facial function based on the modified parent-administered House-Brackmann scale was 94% (n = 75 of 80) vs 89% (n = 72 of 81) at six months (OR 1.88; 95% CI 0.60, 5.86) and 96% (n = 75 of 78) vs 92% (n = 73 of 79) at 12 months (OR 3.12; 95% CI 0.61, 15.98). CONCLUSIONS Although the vast majority had complete recovery of facial function at six months, there were some children without full recovery of facial function at 12 months, regardless of prednisolone use.
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Affiliation(s)
- Franz E Babl
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Critical Care, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia.
| | - David Herd
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia; Mater Research Institute, Brisbane, Queensland, Australia
| | - Meredith L Borland
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Perth Children's Hospital, Perth, Australia; Divisions of Emergency Medicine and Paediatrics, University of Western Australia, Perth, Western Australia
| | - Amit Kochar
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Women's and Children's Hospital, Adelaide, Australia
| | - Ben Lawton
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, The Children's Hospital at Westmead, Sydney, Australia
| | - Adam West
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Australia; School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Australia; Child Health Research Centre, The University of Queensland, South Brisbane, Australia
| | - Ed Oakley
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Critical Care, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia
| | - John A Cheek
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Department of Neurology, Royal Children's Hospital, Victoria, Australia
| | - Stuart R Dalziel
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Parkville Victoria, Australia; Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand; Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Katherine J Lee
- Faculty of Medicine, Dentistry and Health Sciences, Department of Paediatrics, University of Melbourne, Victoria, Australia; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Noda M, Koshu R, Dias M, Onaga R, Ito M. Intact Transmastoid Ossicle Swaying Technique to Preserve Hearing in Pediatric Facial Nerve Decompression Surgery: A Case Report. Cureus 2024; 16:e58269. [PMID: 38752103 PMCID: PMC11094520 DOI: 10.7759/cureus.58269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/18/2024] Open
Abstract
When pharmacological treatments are inadequate, facial nerve paralysis from various etiologies, including Bell's palsy, Hunt syndrome, and trauma, often requires surgical intervention. Facial nerve decompression surgery aims to relieve nerve compression and restore function, with preserving hearing function, especially in pediatric cases, being crucial. Conventional methods, like the transmastoid approach, risk affecting auditory function due to ossicle manipulation. Herein, we describe the case of a 12-year-old boy with left facial palsy diagnosed with zoster sine herpete (ZSH) syndrome. Despite medical treatment, the patient's condition did not improve, prompting facial nerve decompression surgery. Employing the intact transmastoid ossicle (ITO) swaying technique, we minimized ossicular manipulation, preserving auditory function while effectively achieving facial nerve decompression. The patient demonstrated improvement postoperatively in auditory and facial nerve functions. Furthermore, audiometric assessments demonstrated no substantial deterioration in hearing thresholds, and the facial nerve function improved from Grade V to Grade II on the House-Brackmann scale. The ITO technique provides a less invasive alternative compared to conventional approaches, lowering the chance of the ossicular chain and the risk of postoperative hearing loss. This case highlights the significance of customized surgical approaches in pediatric facial nerve decompression surgery, resulting in improved patient outcomes. Further research is required to validate the efficacy and safety of this method across various clinical contexts.
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Affiliation(s)
- Masao Noda
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Ryota Koshu
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Mari Dias
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Ryotaro Onaga
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Makoto Ito
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
- Otolaryngology - Head and Neck Surgery, Jichi Medical University Hospital, Shimotsuke, JPN
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Abdu SH, Alsubhi AH, Alzahrani A, Alshehri A, Al Taylouni N, Rammal A. Comparison of oral versus intravenous steroid in the management of Bell's palsy: a systematic review and meta-analysis of randomized clinical trials. Eur Arch Otorhinolaryngol 2024; 281:1095-1104. [PMID: 37940744 DOI: 10.1007/s00405-023-08288-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Bell's palsy is a condition affecting cranial nerve VII that results in acute peripheral unilateral facial weakness or paralysis of unclear etiology. Corticosteroids are the primary therapy choice, because they improve outcomes. According to a recent study, prednisolone effectively treats Bell's palsy in the short and long term. This study aimed to assess the effectiveness and safety of Single-Dose Intravenous Methylprednisolone to Oral Prednisolone in treating Bell's palsy patients. METHODS PRISMA statement guidelines were used to design and conduct this systemic review. MEDLINE, Cochrane Library, and EMBASE databases were used in our search. We conducted the database search in November 2022. RESULTS Thirty-three publications were reviewed as a result of the literature review. Three studies were included in the meta-analysis after applying our criteria. 317 Bell's palsy patients were included in our study. Regarding complete recovery to grade 1 in 1 month, IV methylprednisolone was higher than oral prednisolone; (log OR = 0.52, 95% CI [0.08, 0.97], P = 0.022). However, at 3 months, the two groups had no significant difference. Patients with grade 4 Bell's palsy were more likely to fully recover to grade 1 in 1 month with IV methylprednisolone than with oral prednisolone (log OR = 0.73, 95% CI [0.19, 1.26], P = 0.008), but not for patients with grade 3 or grade 2 Bell's palsy. CONCLUSION This study shows evidence that patients with Bell's palsy can fully recover to grade 1 in 1 month when IV methylprednisolone is used instead of oral prednisolone. At 3 months, however, there was no discernible difference between the two treatments. Within 3 days of the onset of symptoms, IV methylprednisolone treatment can be started, which may help patients recover fully to grade 1 in 1 month. However, administering IV methylprednisolone may not always have long-term advantages compared to oral prednisolone.
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Affiliation(s)
- Shahad Hani Abdu
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Anas Alzahrani
- Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | | | | | - Almoaidbellah Rammal
- Department of Otolaryngology Head-Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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10
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Deng R, Wang R, Yao M, Ma L. Percutaneous Stylomastoid Foramen Pulsed Radiofrequency Combined with Steroid Injection for Treatment of Intractable Facial Paralysis After Herpes Zoster. Pain Ther 2024; 13:161-172. [PMID: 38175491 PMCID: PMC10796885 DOI: 10.1007/s40122-023-00571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION We investigated the safety and efficacy of percutaneous facial nerve pulsed radiofrequency combined with drug injection for treatment of intractable facial paralysis of herpes zoster. The authors provide a detailed description of percutaneous facial nerve pulsed radiofrequency combined with steroid injection for treatment of intractable facial paralysis after herpes zoster, and they examine its clinical efficacy. This is the first time in the literature to our knowledge that this procedure has been applied in facial paralysis after herpes zoster. METHODS A total of 43 patients with a history of facial paralysis after herpes zoster for > 1 month were enrolled in this retrospective study. The patients were subjected to percutaneous stylomastoid foramen pulsed radiofrequency of the facial nerve under computed tomography (CT) guidance combined with drug injection. The House-Brackmann grades and NRS (Numerical Rating Scale) data collection were performed at different time points (preoperatively, 1 day post-procedure, and 2, 4, and 12 weeks postoperatively). The occurrence of complications was also assessed. RESULTS The 43 participants successfully completed the CT-guided percutaneous stylomastoid foramen pulsed radiofrequency of the facial nerve combined with drug injection. Both approaches [posterior approach of the ear (7 cases) and anterior approach of the ear (36 cases)] were efficacious and safe. The House-Brackmann grades (I, II, III, IV, V, VI) were 4 (3-4), 2 (2-3), 1 (1-2), and 1 (0-2) at different operation times (T0, T1, T2, T3, T4); patients felt significant recovery at T1 after operation and had gradually recovered at each time point but had no significant recovery after T3. The NRS scores at different operation times were 2.690 ± 2.213, 0.700 ± 0.939, 0.580 ± 1.006, 0.440 ± 0.908, and 0.260 ± 0.759, respectively. Differences in NRS scores between T0 and T1/2/3/4 were significant while differences between T1 and T2/3/4 were not significant. Six patients developed mild numbness, nine patients exhibited muscle tension, while one patient exhibited facial stiffness. During surgery, there was no intravascular injection of drugs, no nerve injury was reported, and there was no local anesthetic poisoning or spinal anesthesia. CONCLUSIONS Percutaneous stylomastoid foramen pulsed radiofrequency combined with drug injection of the facial nerve for treatment of intractable facial paralysis after herpes zoster is a minimally invasive technique with high rates of success, safety, and effective outcomes. It is a potential therapeutic option for cases of facial paralysis of herpes zoster with a > 1 month history even for those with severe facial paralysis and whose treatment has failed after oral medication and physiotherapy.
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Affiliation(s)
- Ruyun Deng
- Department of Anesthesiology, Daqing Oilfeld General Hospital, No. 9 Zhongkang Road, Sartu District, Daqing, 163001, China
| | - Ruxiang Wang
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ming Yao
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ling Ma
- Department of Anesthesiology and Pain Medicine, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
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11
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Rajangam J, Lakshmanan AP, Rao KU, Jayashree D, Radhakrishnan R, Roshitha B, Sivanandy P, Sravani MJ, Pravalika KH. Bell Palsy: Facts and Current Research Perspectives. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:203-214. [PMID: 36959147 DOI: 10.2174/1871527322666230321120618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Abstract
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.
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Affiliation(s)
- Jayaraman Rajangam
- AMITY Institute of Pharmacy, AMITY University, Lucknow, Uttar Pradesh, 226028, India
| | | | - K Umamaheswara Rao
- Department of Pharmacology, Sri Venkateswara Institute of Medical Sciences, Sri Padmavati Mahila Visvavidyalayam, Tirupati, Andhra Pradesh, 517507, India
| | - D Jayashree
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, P.O Box 505055, Dubai, UAE
| | - B Roshitha
- Sri Venkateswara Institute of Cancer Care and Advanced Research, Tirupati, Andhra Pradesh, 517507, India
| | - Palanisamy Sivanandy
- School of Pharmacy, International Medical University, No 126, Jalan Jalil Perkasa 19, Bukit Jalil 57000 Kuala Lumpur, Malaysia
| | - M Jyothi Sravani
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - K Hanna Pravalika
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
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12
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Rim HS, Byun JY, Kim SH, Yeo SG. Optimal Bell's Palsy Treatment: Steroids, Antivirals, and a Timely and Personalized Approach. J Clin Med 2023; 13:51. [PMID: 38202059 PMCID: PMC10779900 DOI: 10.3390/jcm13010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
| | | | | | - Seung Geun Yeo
- Department of Otorhinolaryngology—Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea; (H.S.R.); (J.Y.B.); (S.H.K.)
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13
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Choi Y, Lee S, Yang C, Ahn E. The Impact of Early Acupuncture on Bell's Palsy Recurrence: Real-World Evidence from Korea. Healthcare (Basel) 2023; 11:3143. [PMID: 38132033 PMCID: PMC10743002 DOI: 10.3390/healthcare11243143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Evidence-based treatment for Bell's palsy includes the administration of steroids within 3 days of symptom onset. Additionally, a few studies have suggested the importance of combining early acupuncture treatment in the acute phase of Bell's palsy with steroids. This study aimed to observe the impact of early acupuncture for Bell's palsy using real-world health insurance data in Korea. This retrospective study extracted data from 45,986 adult patients with Bell's palsy who received steroids between 2015 and 2017 with a follow-up period of at least 3 years until 2020 from the Korea National Health Insurance database. They were divided into the early acupuncture group (n = 28,267) and the comparison group (n = 17,719) based on the presence of an acupuncture treatment code within 7 days of diagnosis. The impact of early acupuncture on the likelihood of Bell's palsy recurrence was evaluated using multivariate logistic regression. The patients in the early acupuncture group had a lower likelihood of recurrence (odds ratio: 0.81, 95% confidence interval: 0.69-0.95). This study observed a beneficial impact of early acupuncture on Bell's palsy using real-world health insurance data in Korea. Further research is required to confirm these findings.
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Affiliation(s)
- Yujin Choi
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.C.); (C.Y.)
| | - Suji Lee
- Department of Acupuncture and Moxibustion, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea;
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea; (Y.C.); (C.Y.)
| | - Eunkyoung Ahn
- KM Data Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
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14
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Liu SW, Wright DT, Abramczyk E, Hadford SP, Genther DJ, Byrne PJ, Fritz MA, Ciolek PJ. Management, Referral Patterns, and Outcomes in Bell's Palsy: A Single-Institution 903 Patient Series. Otolaryngol Head Neck Surg 2023; 169:858-864. [PMID: 36946693 DOI: 10.1002/ohn.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE In 2013, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published guidelines for Bell's palsy (BP), including recommendations for workup, management, and specialist referral. Patients with BP often present to primary care; however, adherence to guidelines may vary by setting. This study sought to evaluate the management of patients with BP presenting to primary care, emergency department (ED), and urgent care settings. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care center. METHODS Retrospective chart review of patients identified by diagnosis code for BP. RESULTS A total of 903 patients were included; 687 (76.1%) presented to ED, 87 (9.6%) to internal medicine, 77 (8.5%) to family medicine, and 52 (5.8%) to urgent care. On presentation, 804 (89.0%) patients were prescribed corticosteroids and 592 (65.6%) antiviral therapy. Steroid therapy ranged from 1 dose to greater than a 14-day course, with 177 (19.6%) receiving an adequate duration of 10 days or greater. Referrals were provided to facial plastics and/or otolaryngology for 51 patients (5.6%). For all comers, 283 (31.3%) had complete resolution, 197 (21.8%) had an incomplete resolution, 62 (6.9%) had persistent palsy, and 361 (40.0%) lost to follow-up. In assessing the association between clinic setting and management, appropriate corticosteroid therapy (p < .01), imaging (p < .01), and eye care (p < .01) were statistically significant. CONCLUSION Adherence to guidelines for BP management varies amongst providers. In our study cohort, 15.5% of patients received medical therapy in accordance with AAO-HNS guidelines, and only 5.6% were referred to facial plastics. To facilitate more appropriate care, tertiary care institutions may benefit from system-wide care pathways to manage acute BP.
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Affiliation(s)
- Sara W Liu
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Darrell T Wright
- Department of Head and Neck Surgery, Mid-Atlante Permanente Medical Group, Woodbridge, Virginia, USA
| | - Emily Abramczyk
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Stephen P Hadford
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Dane J Genther
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Patrick J Byrne
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Michael A Fritz
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Peter J Ciolek
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
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15
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McGuire B. Updates on Evaluation and Treatment of Common Complaints in Pregnancy. Obstet Gynecol Clin North Am 2023; 50:535-547. [PMID: 37500215 DOI: 10.1016/j.ogc.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Patients experience many new and concerning symptoms during pregnancy and it is the role of the obstetric clinician to provide appropriate guidance, recommendations, and treatment options. Often times, these symptoms are related to hormonal and physiologic changes that occur and will resolve in the postpartum period. However, clinicians must be able to recognize more concerning pathologic symptoms that require further evaluation and treatment. This review provides updates on the evaluation and management of some of the common symptoms during pregnancy.
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Affiliation(s)
- Brenna McGuire
- Department of Obstetrics and Gynecology, University of New Mexico Hospital, UNM Obstetrics & Gynecology, MSC10 5580, 1 University of New Mexico, Albuquerque, NM 87131, USA.
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Zhang C, Dong F, Wu Q, Jin J, Li M, Xu X, Peng Z, Chen Y, Ye M, Liu X, Wang L, Zhong Y. Sunshine duration and solar radiation contributed to severe Bell's palsy: An 11-year time series analysis based on a distributed lag non-linear model model. Medicine (Baltimore) 2023; 102:e34400. [PMID: 37478212 PMCID: PMC10662859 DOI: 10.1097/md.0000000000034400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023] Open
Abstract
Although previous studies have suggested that meteorological factors are associated with Bell's palsy, articles on this topic are rare and the results are inconsistent. We aim to reveal the relationship between exposure to different meteorological factors and the onset of severe Bell's palsy (SBP) with daily data. A case-crossover study based on time-series data was applied, and the minimum risk value of each climatic factor was set as the reference value. We fitted a distributed lag non-linear model (DLNM) which applied quasi-Poisson regression to evaluate the exposure-response association and the lag-response association of meteorological factors on the occurrence of SBP. The mode value and per-decile interval value of each meteorological factor were all included in the analysis. Sensitivity analyses were conducted to test the robustness of results. A total of 863 SBP patients (474 males and 389 females) from 7 hospitals in the Shenzhen Futian District were selected from January 2009 to February 2020. The highest relations effect was tested in the cumulative exposure-response result shown as follows; mean temperature at the minimum value 15.3°C with RR of 10.370 (1.557-69.077) over lag 0 to 13; relative humidity at the 30th value 71% with RR of 8.041 (1.016-63.616) over lag 0 to 14; wind speed at the 90th value 31 (0.1 m/s) with RR of 1.286 (1.038-1.593) over lag 0; mean air pressure at the 30th value 1001.4 (pa) with RR of 9.052 (1.039-78.858) over lag 0 to 5; visibility at the 80th value 26.5 (km) with RR of 1.961 (1.005-1.423) over lag 0 to 2; average total cloud cover at the max value 100 (%) with RR 1.787 (1.014-3.148) over lag 0 to 2; sunshine duration at the 10th value 0.1 (h) with RR of 4.772 (1.018-22.361); daily evaporation shows no relationship in the cumulative result; daily average solar radiation at the minimum value 0 (W/m2) with RR of 5.588 (1.184-26.382). There is a relationship between wind speed and the onset of SBP, while mean air pressure, visibility, and average total cloud cover, especially sunshine duration and solar radiation which showed a strong effect, may be associated with severe clinical symptoms of SBP. Mean temperature and relative humidity may affect the course of SBP.
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Affiliation(s)
- Cuiyi Zhang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Fang Dong
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Qi Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Jinlan Jin
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Mengtao Li
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Xiaojuan Xu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Zhihua Peng
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Yuanting Chen
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Meixia Ye
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Xingli Liu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Lijun Wang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Yinqin Zhong
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
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Xiong X, Huang L, Herd DW, Borland ML, Davidson A, Hearps S, Mackay MT, Lee KJ, Dalziel SR, Dalziel K, Cheek JA, Babl FE. Cost-effectiveness of Prednisolone to Treat Bell Palsy in Children: An Economic Evaluation Alongside a Randomized Controlled Trial. Neurology 2023; 100:e2432-e2441. [PMID: 37072220 PMCID: PMC10264054 DOI: 10.1212/wnl.0000000000207284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/27/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Bell palsy is the third most frequent diagnosis in children with sudden-onset neurologic dysfunction. The cost-effectiveness of treating Bell palsy with prednisolone in children is unknown. We aimed to assess the cost-effectiveness of prednisolone in treating Bell palsy in children compared with placebo. METHODS This economic evaluation was a prospectively planned secondary analysis of a double-blinded, randomized, placebo-controlled superiority trial (Bell Palsy in Children [BellPIC]) conducted from 2015 to 2020. The time horizon was 6 months since randomization. Children aged 6 months to <18 years who presented within 72 hours of onset of clinician-diagnosed Bell palsy and who completed the trial were included (N = 180). Interventions were oral prednisolone or taste-matched placebo administered for 10 days. Incremental cost-effectiveness ratio comparing prednisolone with placebo was estimated. Costs were considered from a health care sector perspective and included Bell palsy-related medication cost, doctor visits, and medical tests. Effectiveness was measured using quality-adjusted life-years (QALYs) based on Child Health Utility 9D. Nonparametric bootstrapping was performed to capture uncertainties. Prespecified subgroup analysis by age 12 to <18 years vs <12 years was conducted. RESULTS The mean cost per patient was A$760 in the prednisolone group and A$693 in the placebo group over the 6-month period (difference A$66, 95% CI -A$47 to A$179). QALYs over 6 months were 0.45 in the prednisolone group and 0.44 in the placebo group (difference 0.01, 95% CI -0.01 to 0.03). The incremental cost to achieve 1 additional recovery was estimated to be A$1,577 using prednisolone compared with placebo, and cost per additional QALY gained was A$6,625 using prednisolone compared with placebo. Given a conventional willingness-to-pay threshold of A$50,000 per QALY gained (equivalent to US$35,000 or £28,000), prednisolone is very likely cost-effective (probability is 83%). Subgroup analysis suggests that this was primarily driven by the high probability of prednisolone being cost-effective in children aged 12 to <18 years (probability is 98%) and much less so for those <12 years (probability is 51%). DISCUSSION This provides new evidence to stakeholders and policymakers when considering whether to make prednisolone available in treating Bell palsy in children aged 12 to <18 years. TRIAL REGISTRATION INFORMATION Australian New Zealand Clinical Trials Registry ACTRN12615000563561.
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Affiliation(s)
- Xiuqin Xiong
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Li Huang
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - David W Herd
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Meredith L Borland
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Andrew Davidson
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Stephen Hearps
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Mark T Mackay
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Katherine J Lee
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Kim Dalziel
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - John A Cheek
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia
| | - Franz E Babl
- From the Centre for Health Policy (X.X., L.H., K.D.), Melbourne School of Population and Global Health, The University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.W.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.B.), University of Western Australia, Perth; Department of Emergency Medicine (A.D., S.H., M.T.M., J.A.C., F.E.B.), Royal Children's Hospital; Murdoch Children's Research Institute (A.D., M.T.M., K.J.L., J.A.C., F.E.B., S.H.), Parkville, Victoria; Department of Anesthesia (A.D.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria; Department of Pediatrics (K.J.L.), Melbourne Medical School, University of Melbourne, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand; and Departments of Paediatrics and Critical Care (J.A.C., F.E.B.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
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18
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Masouris I, Klein M, Angele B, Groß B, Goswami N, Mashood F, Gesell Salazar M, Schubert S, Pfister HW, Koedel U, Schmidt F. Quantitative proteomic analysis of cerebrospinal fluid from patients with idiopathic facial nerve palsy. Eur J Neurol 2023; 30:1048-1058. [PMID: 36504168 DOI: 10.1111/ene.15663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Idiopathic facial palsy (IFP) accounts for over 60% of peripheral facial palsy (FP) cases. The cause of IFP remains to be determined. Possible etiologies are nerve swelling due to inflammation and/or viral infection. In this study, we applied an integrative mass spectrometry approach to identify possibly altered protein patterns in the cerebrospinal fluid (CSF) of IFP patients. METHODS We obtained CSF samples from 34 patients with FP. In four patients, varicella-zoster virus was the cause (VZV-FP). Among the 30 patients diagnosed with IFP, 17 had normal CSF parameters, five had slightly elevated CSF cell counts and normal or elevated CSF protein, and eight had normal CSF cell counts but elevated CSF protein. Five patients with primary headache served as controls. All samples were tested for viral pathogens by PCR and subjected to liquid chromatography tandem mass spectrometry and bioinformatics analysis and multiplex cytokine/chemokine arrays. RESULTS All CSF samples, except those from VZV-FP patients, were negative for all tested pathogens. The protein composition of CSF samples from IFP patients with normal CSF was comparable to controls. IFP patients with elevated CSF protein showed dysregulated proteins involved in inflammatory pathways, findings which were similar to those in VZV-FP patients. Multiplex analysis revealed similarly elevated cytokine levels in the CSF of IFP patients with elevated CSF protein and VZV-FP. CONCLUSIONS Our study revealed a subgroup of IFP patients with elevated CSF protein that showed upregulated inflammatory pathways, suggesting an inflammatory/infectious cause. However, no evidence for an inflammatory cause was found in IFP patients with normal CSF.
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Affiliation(s)
- Ilias Masouris
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Matthias Klein
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Barbara Angele
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Birgit Groß
- Virology Department, Max-von-Pettenkofer-Institute, Ludwig Maximilian University, Munich, Germany
| | - Neha Goswami
- Proteomics Core, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar
| | - Fathima Mashood
- Proteomics Core, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar
| | - Manuela Gesell Salazar
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Sören Schubert
- Virology Department, Max-von-Pettenkofer-Institute, Ludwig Maximilian University, Munich, Germany
| | - Hans-Walter Pfister
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Uwe Koedel
- Department of Neurology, University hospital, Ludwig Maximilian University, Munich, Germany
| | - Frank Schmidt
- Proteomics Core, Weill Cornell Medicine-Qatar, Qatar Foundation-Education City, Doha, Qatar
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19
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Williams A, Eapen N, Kochar A, Lawton B, Hort J, West A, George S, Berkowitz R, Lee KJ, Dalziel SR, Hearps S, Babl FE. Agreement Between House-Brackmann and Sunnybrook Facial Nerve Grading Systems in Bell's Palsy in Children: Secondary Analysis of a Randomized, Placebo-Controlled Multicenter Trial. J Child Neurol 2023; 38:44-51. [PMID: 36740927 DOI: 10.1177/08830738221144082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is limited evidence on the use of facial nerve function grading scales in acute facial nerve paralysis in children. OBJECTIVE To investigate the agreement between and the usability of the House-Brackmann and Sunnybrook scales in children with idiopathic facial paralysis (Bell's palsy) and to compare their ease of administration. METHODS Data from a randomized controlled trial in children aged 6 months to <18 years with Bell's palsy was used. Children were recruited within 72 hours of symptom onset and assessed using the House-Brackmann and the Sunnybrook scales at baseline and at 1, 3, and 6 months until recovered. Agreement between the scales was assessed using the intraclass correlation coefficient (ICC) at each time point and using a Bland-Altman plot. Ease of administration was assessed using an 11-point Likert scale. RESULTS Comparative data were available for 169 of the 187 children randomized. The ICC between the 2 scales across all time points was 0.92 (95% confidence interval [CI] 0.91-0.93), at baseline 0.37 (95% 0.25, 0.51), at 1 month 0.91 (95% CI 0.89-0.94), at 3 months 0.85 (95% CI 0.80-0.89), and at 6 months 0.96 (95% CI 0.95-0.97). The median score for the ease of administration for the House-Brackmann and Sunnybrook scales was 3 (interquartile range [IQR]: 1-5) and 7 (IQR: 4-8) respectively (P < .001, Wilcoxon signed-rank test). CONCLUSIONS There was excellent agreement between House-Brackmann and Sunnybrook scales, with poorer agreement at baseline. Clinicians found the House-Brackmann scale easier to administer. These findings suggest that both scales can be applied in children.
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Affiliation(s)
- Amanda Williams
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nitaa Eapen
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, Australia
| | - Ben Lawton
- Emergency Department, 4607Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Emergency Department, 8538The Children's Hospital at Westmead, Sydney, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Australia.,School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Robert Berkowitz
- Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Department of Otolaryngology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katherine J Lee
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Stephen Hearps
- Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Franz E Babl
- Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, 34361Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.,Department of Critical Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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20
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Doubrovinskaia S, Mooshage CM, Seliger C, Lorenz H, Nagel S, Lehnert P, Purrucker J, Wildemann B, Bendszus M, Wick W, Schönenberger S, Kaulen LD. Neurological autoimmune diseases following vaccinations against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A follow-up study. Eur J Neurol 2023; 30:463-473. [PMID: 36259114 PMCID: PMC9874608 DOI: 10.1111/ene.15602] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE Population-based studies suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines may trigger neurological autoimmunity including immune-mediated thrombotic thrombocytopenia. Long-term characterization of cases is warranted to facilitate patient care and inform vaccine-hesitant individuals. METHODS In this single-center prospective case study with a median follow-up of 387 days long-term clinical, laboratory and imaging characteristics of patients with neurological autoimmunity diagnosed in temporal association (≤6 weeks) with SARS-CoV-2 vaccinations are reported. RESULTS Follow-up data were available for 20 cases (central nervous system demyelinating diseases n = 8, inflammatory peripheral neuropathies n = 4, vaccine-induced immune thrombotic thrombocytopenia n = 3, myositis n = 2, myasthenia n = 1, limbic encephalitis n = 1, giant cell arteritis n = 1). Following therapy, the overall disability level improved (median modified Rankin Scale at diagnosis 3 vs. 1 at follow-up). The condition of two patients worsened despite immunosuppressants possibly related to their autoimmune diagnoses (limbic encephalitis n = 1, giant cell arteritis n = 1). At 12 months' follow-up, 12 patients achieved complete clinical remissions with partial responses in five and stable disease in one case. Correspondingly, autoimmune antibodies were non-detectable or titers had significantly lowered in all, and repeat imaging revealed radiological responses in most cases. Under vigilant monitoring 15 patients from our cohort underwent additional SARS-CoV-2 vaccinations (BNT162b2 n = 12, mRNA-1273 n = 3). Most patients (n = 11) received different vaccines than prior to diagnosis of neurological autoimmunity. Except for one short-lasting relapse, which responded well to steroids, re-vaccinations were well tolerated. CONCLUSIONS In this study long-term characteristics of neurological autoimmunity encountered after SARS-CoV-2 vaccinations are defined. Outcome was favorable in most cases. Re-vaccinations were well tolerated and should be considered on an individual risk/benefit analysis.
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Affiliation(s)
- Sofia Doubrovinskaia
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Christoph M. Mooshage
- Department of NeuroradiologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Corinna Seliger
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Hanns‐Martin Lorenz
- Division of RheumatologyDepartment of Internal Medicine V, University Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Simon Nagel
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
- Department of NeurologyHospital LudwigshafenLudwigshafenGermany
| | - Pascal Lehnert
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Jan Purrucker
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Brigitte Wildemann
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Martin Bendszus
- Department of NeuroradiologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Wolfgang Wick
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Silvia Schönenberger
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
| | - Leon D. Kaulen
- Department of NeurologyUniversity Hospital Heidelberg, Heidelberg UniversityHeidelbergGermany
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21
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Lansing L, Wendel SB, Hultcrantz M, Marsk E. Bell's Palsy in Pregnancy and Postpartum: A Retrospective Case-Control Study of 182 Patients. Otolaryngol Head Neck Surg 2023; 168:1025-1033. [PMID: 36939398 DOI: 10.1002/ohn.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the incidence of Bell's palsy in pregnant and postpartum women. Additionally, to compare facial outcomes in terms of Sunnybrook score following Bell's palsy with regard to corticosteroid treatment and other confounding factors. STUDY DESIGN Retrospective case-control study. SETTING University Hospital, Stockholm, Sweden. METHODS All women with Bell's palsy in pregnancy or postpartum (6 weeks after birth) with a computerized medical chart in the Stockholm Region 2005 to 2015 were included. The total number of births in the region during this period was retrieved from the Swedish Medical Birth Register. Nonpregnant age-matched women with Bell's palsy served as controls. Characteristics, medication, and Sunnybrook scores were collected. Risk factors for incomplete recovery (Sunnybrook score <96) at 3 months were calculated by logistic regression. RESULTS In total, 182 pregnant and postpartum women with Bell's palsy were identified. The estimated incidence among pregnant and postpartum women was 60.5/100,000 person-years. The mean Sunnybrook score at 3 months was 74 among pregnant and postpartum women and 83 for controls (p = .002). At 12 months, Sunnybrook score was 81 and 89, respectively (p = .017). Only one-third of the pregnant women received corticosteroid treatment. CONCLUSION The incidence of Bell's palsy in pregnancy and postpartum was 60.5 per 100,000 women and year in the Stockholm Region. Sunnybrook score was poorer in pregnant women compared with postpartum and nonpregnant women throughout. Corticosteroid treatment had little effect on any patients, however, only one-third of the pregnant women received this treatment.
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Affiliation(s)
- Lovisa Lansing
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Sophia B Wendel
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Women's Health, Danderyd Hospital, Stockholm, Sweden
| | | | - Elin Marsk
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.,Karolinska Institutet, Stockholm, Sweden
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22
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Wamkpah NS, Kallogjeri D, Snyder-Warwick AK, Buss JL, Durakovic N. Incidence and Management of Facial Paralysis After Skull Base Trauma, an Administrative Database Study. Otol Neurotol 2022; 43:e1180-e1186. [PMID: 36214506 PMCID: PMC9649848 DOI: 10.1097/mao.0000000000003721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Report the incidence of and treatment patterns for facial nerve palsy after skull base fracture. STUDY DESIGN Retrospective cohort study. SETTING IBM MarketScan Commercial Database (2006-2019). PATIENTS Human subjects with skull base fracture, per International Classification of Diseases-9th and 10th Revisions-Clinical Modification diagnosis codes. MAIN OUTCOME MEASURES The primary outcomes were the incidence and median time to facial nerve palsy diagnosis within 30 days of skull base fracture. Secondary outcomes were treatments (corticosteroids, antivirals, facial nerve decompression, botulinum toxin, and facial reanimation), demographics, and rates of hearing loss, vertigo, tympanic membrane rupture, cerebrospinal fluid leak, comorbidities, and loss of consciousness. RESULTS The 30-day incidence of facial nerve palsy after skull base trauma was 1.0% (738 of 72,273 patients). The median (95% confidence interval [CI]) time to diagnosis was 6 (6-7) days, and only 22.9% were diagnosed within 1 day. There were significantly higher rates (risk difference, 95% CI) of hearing loss (26%, 22-29%), tympanic membrane rupture (6.3%, 4.5-8.1%), cerebrospinal fluid leak (6.4%, 4.5-8.3%), comorbidity (14%, 10.4-17.6%), and loss of consciousness (24.3%, 20.7-27.9%). Loss of consciousness was associated with longer median (95% CI) time to facial nerve palsy diagnosis: 10 (9-10) days. Corticosteroids were the most common treatment but only reported for less than one-third of patients. Only eight patients underwent facial nerve decompression. CONCLUSIONS Facial nerve palsy after skull base fracture is associated with higher comorbidity, and the diagnosis is often delayed. Few patients were treated with surgery, and there are inconsistencies in the types and timing of treatments.
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Affiliation(s)
- Nneoma S. Wamkpah
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Dorina Kallogjeri
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
| | - Alison K. Snyder-Warwick
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO
| | - Joanna L. Buss
- Institute of Clinical and Translational Sciences, Center for Administrative Data Research, Washington University in St. Louis, St. Louis, MO
| | - Nedim Durakovic
- Department of Otolaryngology—Head and Neck Surgery, Washington University in St. Louis, St. Louis, MO
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Babl FE, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Zhang M, Velusamy K, Sullivan F, Oakley E, Davidson A, Hopper SM, Cheek JA, Berkowitz RG, Hearps S, Wilson CL, Williams A, Elborough H, Legge D, Mackay MT, Lee KJ, Dalziel SR. Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Neurology 2022; 99:e2241-e2252. [PMID: 36008143 DOI: 10.1212/wnl.0000000000201164] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 07/11/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Corticosteroids are used to treat the early stages of idiopathic facial paralysis (Bell palsy) in children, but their effectiveness is uncertain. We set out to determine whether prednisolone improves the proportion of children with Bell palsy with complete recovery at 1 month. METHODS We conducted a double-blind, placebo-controlled, randomized trial of prednisolone in children presenting to emergency departments with Bell palsy. Patients aged 6 months to younger than 18 years were recruited within 72 hours after the symptom onset and were randomly assigned to receive 10 days of treatment with oral prednisolone (approximately 1 mg/kg) or placebo. The primary outcome was complete recovery of facial function at 1 month rated on the House-Brackmann scale. Secondary outcomes included facial function, adverse events, and pain up to 6 months. Target recruitment was n = 540 (270 per group). RESULTS Between October 13, 2015, and August 23, 2020, 187 children were randomized (94 to prednisolone and 93 to placebo) and included in the intention-to-treat analysis. At 1 month, the proportions of patients who had recovered facial function were 49% (n = 43/87) in the prednisolone group compared with 57% (n = 50/87) in the placebo group (risk difference -8.1%, 95% CI -22.8 to 6.7; adjusted odds ratio [aOR] 0.7, 95% CI 0.4 to 1.3). At 3 months, these proportions were 90% (n = 71/79) for the prednisolone group vs 85% (n = 72/85) for the placebo group (risk difference 5.2%, 95% CI -5.0 to 15.3; aOR 1.2, 95% CI 0.4 to 3.0) and, at 6 months, 99% (n = 77/78) and 93% (n = 76/82), respectively (risk difference 6.0%, 95% CI -0.1 to 12.2; aOR 3.0, 95% CI 0.5 to 17.7). There were no serious adverse events and little evidence for group differences in secondary outcomes. DISCUSSION In children with Bell palsy, the vast majority recover without treatment. This study, although underpowered, does not provide evidence that early treatment with prednisolone improves complete recovery. TRIAL REGISTRATION INFORMATION Registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561, registered June 1, 2015. anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368505&isReview=true. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for children with Bell palsy, prednisolone does not significantly change recovery of complete facial function at 1 month. However, this study lacked the precision to exclude an important harm or benefit from prednisolone.
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Affiliation(s)
- Franz E Babl
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand.
| | - David Herd
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Meredith L Borland
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Amit Kochar
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Ben Lawton
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Jason Hort
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Adam West
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Shane George
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Michael Zhang
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Karthik Velusamy
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Frank Sullivan
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Ed Oakley
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Andrew Davidson
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Sandy M Hopper
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - John A Cheek
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Robert G Berkowitz
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Stephen Hearps
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Catherine L Wilson
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Amanda Williams
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Hannah Elborough
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Donna Legge
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Mark T Mackay
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Katherine J Lee
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
| | - Stuart R Dalziel
- From the Emergency Department (F.E.B., E.O., S.M.H., J.A.C., A. Williams, H.E.), Royal Children's Hospital; Clinical Sciences (F.E.B., E.O., A.D., S.M.H., J.A.C., R.G.B., S.H., C.L.W., A. Williams, H.E., M.T.M.), Murdoch Children's Research Institute, Parkville; Departments of Paediatrics (F.E.B., E.O., A.D., S.M.H., R.G.B., M.T.M., K.J.L.) and Critical Care (F.E.B., E.O., S.H.), Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria; Emergency Department (D.H.), Queensland Children's Hospital; University of Queensland (D.H.); Mater Research Institute (D.H.), Brisbane, Queensland; Emergency Department (M.L.B.), Perth Children's Hospital; Divisions of Emergency Medicine and Paediatrics (M.L.B.), University of Western Australia, Perth; Emergency Department (A.K.), Women's and Children's Hospital, Adelaide; Emergency Department (B.L.), Logan Hospital, Brisbane, Queensland; Emergency Department (J.H.), The Children's Hospital at Westmead, Sydney; Emergency Department (A. West, J.A.C.), Monash Medical Centre, Clayton, Victoria; Department of Emergency Medicine (S.G.), Gold Coast University Hospital, Southport; School of Medicine and Menzies Health Institute Queensland (S.G.), Griffith University, Southport; Child Health Research Centre (S.G.), The University of Queensland, South Brisbane; Emergency Department (M.Z.), John Hunter Hospital, Newcastle, New South Wales; Emergency Department (K.V.), Townsville Hospital; James Cook University College of Medicine and Dentistry (K.V.), Townsville, Australia; University of St Andrews (F.S.), School of Medicine, Edinburgh, United Kingdom; North York General Hospital (F.S.), Department of Family & Community Medicine and Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Department of Anaesthesia (A.D.), Royal Children's Hospital; Department of Otolaryngology (R.G.B.), Pharmacy Department (D.L.), and Department of Neurology (M.T.M.), Royal Children's Hospital; Clinical Epidemiology and Biostatistics Unit (K.J.L.) and Melbourne Children's Trial Centre (A.D., K.J.L.), Murdoch Children's Research Institute, Parkville, Victoria, Australia; Children's Emergency Department (S.R.D.), Starship Children's Hospital, Auckland; and Departments of Surgery and Paediatrics: Child and Youth Health (S.R.D.), University of Auckland, New Zealand
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24
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Khan AJ, Szczepura A, Palmer S, Bark C, Neville C, Thomson D, Martin H, Nduka C. Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil 2022; 36:1424-1449. [PMID: 35787015 PMCID: PMC9510940 DOI: 10.1177/02692155221110727] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published between 01 January 2011 and 30 September 2020. METHODS Predetermined inclusion/exclusion criteria were utilised to shortlist abstracts. Two reviewers independently appraised articles, systematically extracted data and assessed the quality of individual studies and reviews (using GRADE and AMSTAR-2, respectively). Thematic analysis used for evidence synthesis; no quantitative meta-analysis conducted. The review was registered with PROSPERO (CRD42017073067). RESULTS Seven new randomised controlled trials, nine observational studies, and three quasi-experimental or pilot studies were identified (n = 854 participants). 75% utilised validated measures to record changes in facial function and/or patient-rated outcomes. High-quality trials (4/7) all reported positive impacts; as did observational studies rated as high/moderate quality (3/9). The benefit of therapy at different time points post-onset and for cases of varying clinical severity is discussed. Differences in study design prevented data pooling to strengthen estimates of therapy effects. Six new review articles identified were all rated critically low quality. CONCLUSION The findings of this targeted review reinforce those of the earlier more general Cochrane review. New research studies strengthen previous conclusions about the benefits of facial exercise therapy early in recovery and add to evidence of the value in chronic cases. Further standardisation of study design/outcome measures and evaluation of cost-effectiveness are recommended.
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Affiliation(s)
- Amir J Khan
- Department of Economics, Institute of Business
Administration, Karachi, Pakistan
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Ala Szczepura
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Shea Palmer
- Centre for Healthcare Research, Coventry University, Coventry, UK
- Centre for Care Excellence, Coventry University & University
Hospital Coventry & Warwickshire, Coventry, UK
| | - Chris Bark
- Lanchester Library, Coventry University, Coventry, UK
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - David Thomson
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - Helen Martin
- St Helens and Knowsley Teaching Hospitals
NHS Trust, Liverpool, UK
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
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25
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Alanazi F, Kashoo FZ, Alduhishy A, Aldaihan M, Ahmad F, Alanazi A. Incidence rate, risk factors, and management of Bell's palsy in the Qurayyat region of Saudi Arabia. PeerJ 2022; 10:e14076. [PMID: 36221264 PMCID: PMC9548320 DOI: 10.7717/peerj.14076] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/27/2022] [Indexed: 01/20/2023] Open
Abstract
Background Bell's palsy is an idiopathic facial nerve dysfunction causing temporary paralysis of muscles of facial expression. This study aimed to determine the incidence rate, common risk factors, and preferred treatment by the Saudi patients with Bell's palsy. Method This cross-sectional study was carried out in the Qurayyat region of Saudi Arabia. The retrospective medical records were searched from 2015-2020 of patients diagnosed with Bell's palsy at Qurayyat General Hospital and King Fahad hospital. A 28-item questionnaire was developed by a team of experts and pre-tested among patients with Bell's palsy before being sent to the eligible participants. The data were analyzed using summary statistics, Chi-square test, Fisher exact test and Likelihood ratio test. Results We identified 279 cases of Bell's palsy from the medical records of the hospitals from the years 2015 to 2020, accounting for 46.5 cases per year and an incidence rate of 25.7 per 100,000 per year. Out of 279 patients with Bell's palsy, only 171 returned the questionnaire accounting for a response rate of 61.2%. Out of 171 patients with Bell's palsy, females (n = 147, 86.0%) accounted for the majority of cases. The most affected age group among participants with Bell's palsy was 21-30 years (n = 76, 44.4%). There were 153 (89.5%) cases who reported Bell's palsy for the first time. The majority of the participants experienced right-sided facial paralysis (n = 96, 56.1%). Likelihood ratio test revealed significant relationship between exposure to cold air and common cold with age groups (χ 2(6, N = 171) = 14.92, p = 0.021), χ 2(6, N = 171) = 16.35, pp = 0.012 respectively. The post hoc analyses revealed that participants in the age group of 20-31-years were mostly affected due to exposure to cold air and common cold than the other age groups. The main therapeutic approach preferred was physiotherapy (n = 149, 87.1%), followed by corticosteroids and antivirals medications (n = 61, 35.7%), acupressure (n = 35, 20.5%), traditional Saudi herb medicine (n = 32, 18.7%), cauterization by hot iron rod (n = 23, 13.5%), supplementary therapy (n = 2, 1.2%), facial cosmetic surgery (n = 1, 0.6%) and no treatment (n = 1, 0.6%). The most preferred combined therapy was physiotherapy (87.6%) with corticosteroid and antiviral drugs (35.9%), and acupressure (17.6%). Conclusion The rate of Bell's palsy was approximately 25.7 per 100,000 per year in the Qurayyat region of Saudi Arabia. Exposure to cold air and common cold were the significant risk factors associated with Bell's palsy. Females were predominantly affected by Bell's palsy in the Qurayyat region of Saudi Arabia. Bell's palsy most commonly occurred in the age group 21-30 years. The most favored treatment was physiotherapy following Bell's palsy.
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Affiliation(s)
- Fahad Alanazi
- Department of Physical Therapy and Rehabilitation Sciences, College of Applied Medical Sciences, Jouf University, Al Jouf, Saudi Arabia
| | - Faizan Z. Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Anas Alduhishy
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mishal Aldaihan
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
| | - Ahmad Alanazi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Riyadh, Saudi Arabia
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26
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Lovin BD, Sweeney AD, Chapel AC, Alfonso K, Govil N, Liu YCC. Effects of Age on Delayed Facial Palsy After Otologic Surgery: A Systematic Review and Meta-Analysis. Ann Otol Rhinol Laryngol 2022; 131:1092-1101. [PMID: 34706584 DOI: 10.1177/00034894211053966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To report 4 cases of delayed facial palsy (DFP) after pediatric middle ear (ME) surgery and systematically review and analyze the associated literature to evaluate the effects of age on DFP etiology, management, and prognosis. METHODS Systematic review of PubMed, Cochrane Library, and Embase for articles related to DFP after cochlear implantation (CI) was performed. These articles were assessed for level of evidence, methodological limitations, and number of cases. Meta-analysis was performed to assess the effects of age on DFP incidence. Furthermore, a comprehensive list of all pediatric DFP cases after otologic surgery was assembled through a multi-institutional retrospective review and systematic review of the literature. RESULTS Twenty-nine articles fit the criteria for inclusion in the meta-analysis. The incidence of DFP after CI was 0.23% and 1.01% for pediatric and adult cases, respectively. This difference was statistically significant (P < .001, odds ratio 4.36). Twenty-three cases, adding to the 4 presented herein, were suitable for a comprehensive list. The mean age was 6.9 years. Average postoperative day of paresis onset was 5.4, with an average maximum House-Brackmann grade of 3.5. All patients obtained full facial recovery after an average of 23.5 days. CONCLUSIONS The systematic review demonstrates that DFP after pediatric CI is rare and occurs at a significantly lower rate than in adults, further supporting the viral reactivation hypothesis of DFP. The prognosis for pediatric DFP after otologic surgery is excellent, with a high rate of full recovery in a short time frame. However, steroid administration can be considered. LEVEL OF EVIDENCE IIa.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA.,Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Kristan Alfonso
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Nandini Govil
- Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.,Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yi-Chun Carol Liu
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.,Division of Otolaryngology, Department of Surgery-Head and Neck Surgery, Texas Children's Hospital, Houston, TX, USA
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27
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Yang LS, Zhou DF, Zheng SZ, Zhao BM, Li HG, Chen QQ, Zhong Y, Yang HZ, Zhang K, Tang CZ. Early intervention with acupuncture improves the outcome of patients with Bell's palsy: A propensity score-matching analysis. Front Neurol 2022; 13:943453. [PMID: 36188388 PMCID: PMC9517937 DOI: 10.3389/fneur.2022.943453] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Although acupuncture is widely used as a complementary therapy in the treatment of Bell's palsy (BP) when to initiate acupuncture is still controversial. This study aims to determine the efficacy of the early intervention by acupuncture on BP. Methods We retrospectively gathered clinical data from the Third Affiliated Hospital of SUN-YAT SEN University between 2016 and 2021. We selected newly diagnosed patients with BP who were diagnosed by registered neurologists or acupuncturists formally. The qualified patients were divided into two groups according to whether or not initial acupuncture treatment was given within 7 days from the onset of palsy. Cohorts were balanced using 1:1 propensity score matching (PSM). Cox proportional hazards modeling and Kaplan–Meier analysis were applied to determine the differences between the two groups. The outcome included time to complete recovery of facial function, the rate of complete recovery, and the occurrence of sequelae in 24 weeks. Results A total of 345 patients were eligible for this study and were divided into the manual acupuncture/electroacupuncture (MA/EA) group (n = 76) and the EA group (n = 125). In the propensity score-matched cohort, the time to complete recovery was significantly shorter in the MA/EA group compared with the patients in the EA group (hazard ratio 1.505, 95% CI 1.028–2.404, p <0.05). The MA/EA group had a higher rate of favorable outcomes at 12 weeks than the EA group (93.4 vs. 80.3%, p = 0.032), and the occurrence of sequelae at 24 weeks showed a greater reducing trend in the MA/EA group than the EA group (6.6 vs. 16.4%, p = 0.088). Conclusion Acupuncture intervention at the acute stage of BP could shorten the time to recovery and improve the outcome. Clinical trial registration http://www.chictr.org.cn, identifier ChiCTR 2200058060.
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Affiliation(s)
- Lian-Sheng Yang
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dan-Feng Zhou
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shu-Zhen Zheng
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bai-Ming Zhao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huo-Gui Li
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qi-Qing Chen
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yun Zhong
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hong-Zhi Yang
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kun Zhang
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- *Correspondence: Kun Zhang
| | - Chun-Zhi Tang
- South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
- Chun-Zhi Tang
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28
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Neville C, Gwynn T, Young K, Jordan E, Malhotra R, Nduka C, Kannan RY. Comparative Study of Multimodal Therapy in Facial Palsy Patients. Arch Plast Surg 2022; 49:633-641. [PMID: 36159376 PMCID: PMC9507561 DOI: 10.1055/s-0042-1756352] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/07/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction
In chronic facial palsy, synkinetic muscle overactivity and shortening causes muscle stiffness resulting in reduced movement and functional activity. This article studies the role of multimodal therapy in improving outcomes.
Methods
Seventy-five facial palsy patients completed facial rehabilitation before being successfully discharged by the facial therapy team. The cohort was divided into four subgroups depending on the time of initial attendance post-onset. The requirement for facial therapy, chemodenervation, or surgery was assessed with East Grinstead Grade of Stiffness (EGGS). Outcomes were measured using the Facial Grading Scale (FGS), Facial Disability Index, House-Brackmann scores, and the Facial Clinimetric Evaluation scale.
Results
FGS composite scores significantly improved posttherapy (mean-standard deviation, 60.13 ± 23.24 vs. 79.9 ± 13.01; confidence interval, –24.51 to –14.66,
p
< 0.0001). Analysis of FGS subsets showed that synkinesis also reduced significantly (
p
< 0.0001). Increasingly, late clinical presentations were associated with patients requiring longer durations of chemodenervation treatment (
p
< 0.01), more chemodenervation episodes (
p
< 0.01), increased doses of botulinum toxin (
p
< 0.001), and having higher EGGS score (
p
< 0.001).
Conclusions
This study shows that multimodal facial rehabilitation in the management of facial palsy is effective, even in patients with chronically neglected synkinesis. In terms of the latency periods between facial palsy onset and treatment initiation, patients presenting later than 2 years were still responsive to multimodal treatment albeit to a lesser extent, which we postulate is due to increasing muscle contracture within their facial muscles.
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Affiliation(s)
- Catriona Neville
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Tamsin Gwynn
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Karen Young
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Elizabeth Jordan
- Department of Psychological Therapy, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Raman Malhotra
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom.,Department of Oculoplastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Charles Nduka
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Ruben Yap Kannan
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, United Kingdom
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29
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Jančić J, Zeković J, Ćetković M, Nikolić B, Ivančević N, Vučević D, Nešić Z, Milovanović S, Radenković M, Samardžić J. Acute Peripheral Facial Nerve Palsy in Children and Adolescents: Clinical Aspects and Treatment Modalities. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2022; 22:CNSNDDT-EPUB-126028. [PMID: 36045521 DOI: 10.2174/1871527321666220831095204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/07/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Peripheral facial nerve palsy is a relatively frequent, rather idiopathic, and isolated nonprogressive disorder with a tendency toward spontaneous recovery in children. It is primarily characterized by unilateral paresis or paralysis of the mimic musculature affecting verbal communication, social interactions, and quality of life. OBJECTIVE This study aimed to evaluate the clinical aspects and efficacy of different therapeutic modalities in the population of children and adolescents with acute peripheral facial nerve palsy, the quality and recovery rate in comparison to different therapy modalities and etiological factors as well as to determine parameters of recovery according to the age of patients. METHODS The retrospective study included children and adolescents (n=129) with an acute onset of peripheral facial nerve palsy, diagnosed and treated in the Clinic of Neurology and Psychiatry for Children and Youth in Belgrade (2000-2018). The mean age of the patients was 11.53 years (SD±4.41). Gender distribution: 56.6% female and 43.4% male patients. RESULTS There were 118 (91.5%) patients with partial and 11 (8.5%) patients with complete paralysis. Left-sided palsy occurred in 67 (51.9%) patients, right-sided in 58 (45.0%), while there were 4 (3.1%) bilateral paralyses. The most common etiological factor was idiopathic (Bell's palsy) - 74 (57.4%) patients followed by middle ear infections - 16 (12.4%). Regardless of etiology, age, and therapy protocols, there was a significant recovery in most of the patients (p<0.001), without significant differences in recovery rate. Comparison of inpatient and outpatient populations showed significant differences regarding the number of relapses, severity of clinical presentation, and recovery rate in relation to etiology. CONCLUSION Bell's palsy is shown to be the most common cause of peripheral facial nerve palsy in children and adolescents, regardless of gender. It is followed by mid-ear infections, respiratory infections, and exposure to cold. Most children and adolescents recovered in three weeks after initial presentation, regardless of etiology, age, and therapy.
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Affiliation(s)
- Jasna Jančić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Janko Zeković
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Mila Ćetković
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, Serbia
| | - Blažo Nikolić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Nikola Ivančević
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
| | - Danijela Vučević
- Institute of Pathophysiology \\\'Ljubodrag Buba Mihailovic\\\', Faculty of Medicine, University of Belgrade, Serbia
| | - Zorica Nešić
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Srđan Milovanović
- Clinic of Psychiatry, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Miroslav Radenković
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
| | - Janko Samardžić
- Clinic of Neurology and Psychiatry for Children and Youth, Faculty of Medicine, University of Belgrade, Serbia
- Institute of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, Serbia
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Oliveira J E Silva L, Khoujah D, Naples JG, Edlow JA, Gerberi DJ, Carpenter CR, Bellolio F. Corticosteroids for patients with vestibular neuritis: an evidence synthesis for guidelines for reasonable and appropriate care in the emergency department. Acad Emerg Med 2022; 30:531-540. [PMID: 35975654 DOI: 10.1111/acem.14583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/10/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND A short course of corticosteroids is among the management strategies considered by specialists for the treatment of vestibular neuritis (VN). We conducted an umbrella review (systematic review of systematic reviews) to summarize the evidence of corticosteroids use for the treatment of VN. METHODS We included systematic reviews of randomized controlled trials (RCTs) and observational studies that evaluated the effects of corticosteroids as compared to placebo or usual care in adult patients with acute VN. Titles, abstracts, and full texts were screened in duplicate. The quality of reviews was assessed with the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) tool. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment was used to rate certainty of evidence. No meta-analysis was performed. RESULTS From 149 titles, 5 systematic reviews were selected for quality assessment, and 2 reviews were of higher methodological quality and were included. These 2 reviews included 12 individual studies and 660 patients with VN. In a meta-analysis of 2 RCTs including a total of 50 patients, the use of corticosteroids (as compared to placebo) was associated with higher complete caloric recovery (risk ratio 2.81, 95% CI 1.32 to 6.00, low certainty). It is very uncertain whether this translates into clinical improvement as shown by the imprecise effect estimates for outcomes such as patient-reported vertigo or patient-reported dizziness disability. There was a wide confidence interval for the outcome of dizziness handicap score (1 study, 30 patients, 20.9 points in corticosteroids group vs 15.8 points in placebo, mean difference +5.1, 95% CI -8.09 to +18.29, very low certainty). Higher rates of minor adverse effects for those receiving corticosteroids were reported, but the certainty in this evidence was very low. CONCLUSIONS There is limited evidence to support the use of corticosteroids for the treatment of vestibular neuritis in the emergency department.
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Affiliation(s)
- Lucas Oliveira J E Silva
- Department of Emergency Medicine, Hospital de Clínicas de Porto Alegre, RS, Brazil.,Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
| | - Danya Khoujah
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - James G Naples
- Division of Otolaryngology-Head & Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | | | | | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, United States
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Koukoulithras I, Drousia G, Kolokotsios S, Plexousakis M, Stamouli A, Roussos C, Xanthi E. A Holistic Approach to a Dizzy Patient: A Practical Update. Cureus 2022; 14:e27681. [PMID: 36106247 PMCID: PMC9447938 DOI: 10.7759/cureus.27681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2022] [Indexed: 11/07/2022] Open
Abstract
Dizziness is one of the most common symptoms encountered by physicians daily. It is divided into four categories: vertigo, disequilibrium, presyncope, and psychogenic dizziness. It is essential to distinguish these four symptoms because the causes, prognosis, and treatment differ. Vertigo constitutes a disease of the central or peripheral nervous system. Central origin vertigo may be a life-threatening situation and must be detected as soon as possible because it includes diseases such as stroke, hemorrhage, tumors, and multiple sclerosis. Peripheral origin vertigo includes benign diseases, which may be fully treatable such as vestibular migraine, benign paroxysmal positional vertigo, vestibular neuritis, Ménière’s disease, and cervical vertigo. The HINTS (head impulse, nystagmus, test of skew) examination is essential to distinguish central from peripheral causes. A detailed history including the duration of vertigo (episodic or continuous), its trigger, and a clinical examination step by step following the appropriate protocol could help to make a definite and accurate diagnosis and treatment. Due to a lack of expertise in dizziness and inappropriate treatment, many patients are admitted to dizziness clinics with long-standing dizziness. A holistic treatment combining medications, vestibular rehabilitation, physiotherapy, and psychotherapy should be initiated to improve the quality of life of these patients. So, this review aims to recommend a clinical protocol for approaching a dizzy patient with vertigo and to present in detail the epidemiology, pathophysiology, symptoms, diagnosis, and contemporary treatments of all causes of vertigo.
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Review of Drug Therapy for Peripheral Facial Nerve Regeneration That Can Be Used in Actual Clinical Practice. Biomedicines 2022; 10:biomedicines10071678. [PMID: 35884983 PMCID: PMC9313135 DOI: 10.3390/biomedicines10071678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022] Open
Abstract
Although facial nerve palsy is not a life-threatening disease, facial asymmetry affects interpersonal relationships, causes psychological stress, and devastates human life. The treatment and rehabilitation of facial paralysis has many socio-economic costs. Therefore, in cases of facial paralysis, it is necessary to identify the cause and provide the best treatment. However, until now, complete recovery has been difficult regardless of the treatment used in cases of complete paralysis of unknown cause and cutting injury of the facial nerve due to disease or accident. Therefore, this article aims to contribute to the future treatment of facial paralysis by reviewing studies on drugs that aid in nerve regeneration after peripheral nerve damage.
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Guez-Barber D, Swami SK, Harrison JB, McGuire JL. Differentiating Bell's Palsy From Lyme-Related Facial Palsy. Pediatrics 2022; 149:188058. [PMID: 35586981 PMCID: PMC9648116 DOI: 10.1542/peds.2021-053992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To describe the etiology and clinical course of pediatric acute-onset unilateral peripheral facial palsy (FP), to define factors that distinguish Bell's palsy from Lyme-related FP (LRFP), and to determine if early corticosteroid use impacts facial strength recovery in Bell's palsy or LRFP. METHODS Retrospective cohort study of children 1 to 18 years old who received clinical care within our pediatric clinical care network (Lyme-endemic region) between 2013 and 2018 for acute-onset unilateral peripheral FP. RESULTS The study included 306 children; 82 (27%) had LRFP, 209 (68%) had Bell's palsy, and 15 (5%) had FP of different etiology. Most children with LRFP presented between June and November (93%), and compared with Bell's palsy, more often had a preceding systemic prodrome, including fever, malaise, headache, myalgias, and/or arthralgias (55% vs 6%, P < .001). Neuroimaging and lumbar puncture did not add diagnostic value in isolated FP. Of the 226 children with Bell's palsy or LRFP with documented follow-up, FP was resolved in all but 1. There was no association between ultimate parent/clinician assessment of recovery and early corticosteroid use. CONCLUSIONS Bell's palsy and LRFP were common causes of pediatric FP in our Lyme endemic region. Systemic prodrome and calendar month may help distinguish LRFP from Bell's palsy at FP onset, guiding antibiotic use. Early corticosteroid use did not impact our measures of recovery, although subtle abnormalities may not have been appreciated, and time to recovery could not be assessed. Future prospective studies using standardized assessment tools at regular follow-up intervals are necessary.
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Affiliation(s)
| | - Sanjeev K Swami
- Infectious Disease, The Children’s Hospital of
Philadelphia, Philadelphia, Pennsylvania,Pediatrics, The Perelman School of Medicine at the
University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jennifer L McGuire
- Divisions of Neurology,Departments of Neurology,Pediatrics, The Perelman School of Medicine at the
University of Pennsylvania, Philadelphia, Pennsylvania,Address correspondence to Jennifer L McGuire, MD, MSCE, Division
of Neurology at The Children’s Hospital of Philadelphia, Assistant
Professor, Departments of Neurology and Pediatrics at Perelman School of
Medicine at the University of Pennsylvania, 34th St and Civic Center Blvd,
Philadelphia, PA 19104. E-mail:
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Dorjey Y. Bell's palsy with preeclampsia in pregnancy. Clin Case Rep 2022; 10:e05918. [PMID: 35620256 PMCID: PMC9127246 DOI: 10.1002/ccr3.5918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 12/02/2022] Open
Abstract
Bell's palsy in pregnancy is not frequently seen. The association of preeclampsia with Bell's palsy is reported in the research, however, the exact link between Bell's palsy and preeclampsia is unknown. The treatment of Bell's palsy during the pregnancy is difficult and controversial. We report two cases of Bell's palsy with preeclampsia diagnosed during the third trimester of the pregnancy. The first case was diagnosed with Bell's palsy with severe preeclampsia with placental abruption with fetal distress; the pregnancy was terminated by cesarean section. Another case was diagnosed with Bell's palsy with mild preeclampsia. She had a spontaneous vaginal delivery at term. Both the cases achieved complete recovery from Bell's palsy after treatment with corticosteroid and antiviral drugs. Every obstetrician should be able to recognize Bell's palsy in pregnancy and initiate early treatment with corticosteroid and mount surveillance for preeclampsia.
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Kurz A, Volk GF, Arnold D, Schneider-Stickler B, Mayr W, Guntinas-Lichius O. Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis. Front Neurol 2022; 13:869900. [PMID: 35444611 PMCID: PMC9013944 DOI: 10.3389/fneur.2022.869900] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/18/2022] [Indexed: 12/30/2022] Open
Abstract
This article addresses the potential clinical value of surface electrical stimulation in the acute phase of denervation after the onset of facial nerve or recurrent laryngeal nerve paralysis. These two nerve lesions are the most frequent head and neck nerve lesions. In this review, we will work out several similarities concerning the pathophysiology features and the clinical scenario between both nerve lesions, which allow to develop some general rules for surface electrical stimulation applicable for both nerve lesions. The focus is on electrical stimulation in the phase between denervation and reinnervation of the target muscles. The aim of electrostimulation in this phase of denervation is to bridge the time until reinnervation is complete and to maintain facial or laryngeal function. In this phase, electrostimulation has to stimulate directly the denervated muscles, i.e. muscle stimulation and not nerve stimulation. There is preliminary data that early electrostimulation might also improve the functional outcome. Because there are still caveats against the use of electrostimulation, the neurophysiology of denervated facial and laryngeal muscles in comparison to innervated muscles is explained in detail. This is necessary to understand why the negative results published in several studies that used stimulation parameters are not suitable for denervated muscle fibers. Juxtaposed are studies using parameters adapted for the stimulation of denervated facial or laryngeal muscles. These studies used standardized outcome measure and show that an effective and tolerable electrostimulation of facial and laryngeal muscles without side effects in the early phase after onset of the lesions is feasible, does not hinder nerve regeneration and might even be able to improve the functional outcome. This has now to be proven in larger controlled trials. In our view, surface electrical stimulation has an unexploited potential to enrich the early therapy concepts for patients with unilateral facial or vocal fold paralysis.
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Affiliation(s)
- Annabella Kurz
- Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.,Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Dirk Arnold
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany
| | - Berit Schneider-Stickler
- Department of Otorhinolaryngology, Division of Phoniatrics-Logopedics, Medical University of Vienna, Vienna, Austria
| | - Winfried Mayr
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany.,Center for Rare Diseases, Jena University Hospital, Jena, Germany
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Shi J, Lu D, Chen H, Shu M, Xu Y, Qian J, Ouyang K, Huang H, Luo Z, Wang C, Zhang Y. Efficacy and Safety of Pharmacological and Physical Therapies for Bell's Palsy: A Bayesian Network Meta-Analysis. Front Neurol 2022; 13:868121. [PMID: 35528739 PMCID: PMC9074786 DOI: 10.3389/fneur.2022.868121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The objective was to comprehensively assess the efficacy and safety of all pharmacological and physical treatments (short-term, ≤ 1 month) for patients with acute Bell's palsy. Methods The electronic databases PubMed, Web of Science, Embase, Cochrane Library, and CNKI were searched for the randomized controlled trials comparing two or more regimens in patients with the Bell's palsy to be included in a Bayesian network meta-analysis. Odds ratios and CIs for the primary outcome of the House–Brackmann scale and secondary outcomes of sequelae (synkinesis and crocodile tears) and adverse events were obtained and subgroup analyses of steroids and antivirals were conducted. Results A total of 26 studies representing 3,609 patients having undergone 15 treatments matched our eligibility criteria. For facial recovery, acupuncture plus electrical stimulation, steroid plus antiviral plus Kabat treatment, and steroid plus antiviral plus electrical stimulation were the top three options based on analysis of the treatment ranking (probability = 84, 80, and 77%, respectively). Steroid plus antiviral plus electrical stimulation had the lowest rate of sequelae but were more likely to lead to mild adverse events. Subgroup analysis revealed that methylprednisolone and acyclovir were likely to be the preferred option. Conclusions This network meta-analysis indicated that combined therapies, especially steroid plus antiviral plus Kabat treatment, were associated with a better facial function recovery outcome than single therapy. Other physical therapies, such as acupuncture plus electrical stimulation, may be a good alternative for people with systemic disease or allergies. More high-quality trials of physical regimens are needed in the future. Systematic Review Registration Our registered PROSPERO number is CRD42021275486 and detailed information can be found at https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Jianwei Shi
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Dafeng Lu
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hairong Chen
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Mingzhu Shu
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Xu
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jiaojiao Qian
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Ke Ouyang
- Department of Infectious Diseases, Jiangsu People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Huaying Huang
- Department of Infectious Diseases, Jiangsu People's Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, China
| | - Zhengxiang Luo
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chunhui Wang
- School of Public Health, Nanjing Medical University, Nanjing, China
- Center for Disease Control and Prevention of Eastern Theater Command, Nanjing, China
- *Correspondence: Chunhui Wang
| | - Yansong Zhang
- Department of Neurosurgery, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- Yansong Zhang
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Estakhr M, Tabrizi R, Ghotbi Z, Shahabi S, Habibzadeh A, Bashi A, Borhani-Haghighi A. Is facial nerve palsy an early manifestation of COVID-19? A literature review. Am J Med Sci 2022; 364:264-273. [PMID: 35429449 PMCID: PMC9007824 DOI: 10.1016/j.amjms.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/04/2022] [Accepted: 04/08/2022] [Indexed: 11/01/2022]
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Margulis I, Cohen-Kerem R, Roitman A, Gez-Reder H, Aviram A, Bitterman-Fisher S, Kugelman N, Doweck I. Laboratory and imaging findings of necrotizing otitis externa are associated with pathogen type and disease outcome: A retrospective analysis. EAR, NOSE & THROAT JOURNAL 2022:1455613221080973. [PMID: 35311376 DOI: 10.1177/01455613221080973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine associations of laboratory and imaging data with diagnostic parameters of necrotizing otitis externa (NOE) and its severity, and to compare between bacterial and fungal infections. METHODS Records of patients diagnosed with NOE during 2010-2018 at the Department of Otolaryngology, Head and Neck Surgery were reviewed retrospectively for demographics; disease characteristics; and laboratory, scintigraphy, and imaging results. RESULTS Of 48 patients with NOE, the mean age is 73±11.6 years; 32 (67%) were males; 83% had diabetes mellitus. Common pathogens were pseudomonas (49%) and fungi (33%). Sensitivities of the technetium-scan (SPECT ratio ≥1.5), temporal bone computed tomography (CT), and gallium-scan (SPECT ratio ≥1.3) were: 78.7%, 48.8%, and 31.4%, respectively. Gallium-scan results correlated positively with CT bone involvement (p=0.002) and hospital length of stay (p=0.0014). C-reactive protein (CRP) level correlated with hospital length of stay (p=0.028) and positive technetium-scan results (p=0.012). Fungal infection had a higher technetium SPECT ratio (2.16 vs. 1.77, p=0.04), gallium SPECT ratio (1.4 vs. 1.2, p=0.02), longer duration of systemic treatment (87.4 vs. 37.9 days, p=0.014), and longer hospital length of stay (31.6 vs. 15.2 days, p=0.004) compared to non-fungal infection. Eight (17%) patients had responded poorly to treatment. Fungal pathogens, facial nerve paresis, extra-auricular, and bilateral disease were more prevalent among the non-responders. CONCLUSION The technetium scan has higher sensitivity than temporal bone CT for diagnosing NOE. The gallium scan and CRP correlated well with hospital length of stay. A high rate of fungal infection was found, with significantly higher technetium and gallium SPECT ratios and worse outcome compared to bacterial infection. Fungal NOE remains therapeutically challenging.
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Affiliation(s)
- Itai Margulis
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Raanan Cohen-Kerem
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Roitman
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Hadar Gez-Reder
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Aviram
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sivan Bitterman-Fisher
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Nir Kugelman
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ilana Doweck
- Department of Otolaryngology Head and Neck Surgery, 37255Lady Davis Carmel Medical Center, and the Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Ton G, Lee LW, Ho WC, Tu CH, Chen YH, Lee YC. Effects of Laser Acupuncture Therapy for Patients With Inadequate Recovery From Bell's Palsy: Preliminary Results From Randomized, Double-Blind, Sham-Controlled Study. J Lasers Med Sci 2022; 12:e70. [PMID: 35155155 DOI: 10.34172/jlms.2021.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/31/2021] [Indexed: 01/27/2023]
Abstract
Introduction: Inadequate recovery from Bell's palsy exists in a third of patients and results in physical and social impairments. The controversial nature of existing medical treatment options means that novel, alternative approaches are needed. In basic and clinical studies, low-level laser therapy (LLLT) has proven successful in regenerating peripheral nerves. Laser acupuncture therapy (LAT) is a rapidly growing treatment modality; however, its effectiveness for treating chronic Bell's palsy is unknown. The feasibility of this innovative approach is the focus of this pilot study. Methods: A two-armed, parallel, randomized, investigator-subject-assessor-blinded, sham-controlled pilot study was conducted, and 17 eligible subjects were randomly allocated to either LAT (n=8) or sham LAT (n=9). The LAT group received three treatments each week for six weeks (18 sessions), while the sham LAT group received the same procedure but with a sham laser device. The change from baseline to week 6 in the social subscale of the Facial Disability Index (FDI) was the primary outcome. Secondary outcomes were changes in the House-Brackmann facial paralysis scale (HB), the Sunnybrook facial grading system (SB) and a stiffness scale at weeks 3 and 6. Results: A significant difference was shown in the HB score (P=0.0438) between baseline and week 3 and borderline significance was observed in both SB and stiffness scores from baseline to week 6 (P=0.0598 and P=0.0980 respectively). There was no significant difference in the FDI score between baseline and week 6. Conclusion: To the best of our knowledge, this clinical trial is the first such investigation on this topic. Our findings suggest that using LAT may have clinical effects on long-term complications of Bell's palsy and justify further large-scale studies.
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Affiliation(s)
- Gil Ton
- College of Chinese medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan
| | - Li-Wen Lee
- Department of Acupuncture, China Medical University Hospital, Taichung 40402 Taiwan
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung 40402, Taiwan
| | - Cheng-Hao Tu
- College of Chinese medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan
| | - Yi-Hung Chen
- College of Chinese medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan
| | - Yu-Chen Lee
- College of Chinese medicine, Graduate Institute of Acupuncture Science, China Medical University, Taichung 40402, Taiwan.,Department of Acupuncture, China Medical University Hospital, Taichung 40402 Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung 40402 Taiwan
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Comparison of Medical and Surgical Treatment in Severe Bell's Palsy. J Clin Med 2022; 11:jcm11030888. [PMID: 35160337 PMCID: PMC8836601 DOI: 10.3390/jcm11030888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: The effectiveness of decompression surgery for Bell’s palsy is controversial. This study investigated the effects of facial nerve decompression in patients with severe Bell’s palsy who were expected to have a poor prognosis. (2) Methods: We retrospectively reviewed 1721 patients with Bell’s palsy who visited the Kyung Hee University Hospital between January 2005 and December 2021. Of these, 45 patients with severe Bell’s palsy were divided into two groups; 30 patients were treated conservatively with steroids and antiviral agents alone, while 15 patients underwent additional decompressive surgery after the conservative treatment. Outcomes were measured using House–Brackmann (H–B) grade for least 6 months after treatment was finished and conducted until full recovery was achieved. (3) Results: There was no significant difference in the rate of favorable recovery (H–B grade 1 or 2) between the surgery group and the conservative treatment group (75% vs. 70.0%, p > 0.05). Although H–B grade improvement occurred in both groups, the degree of improvement was not significantly different between groups. (4) Conclusions: Facial nerve decompression surgery in severe Bell’s palsy patients did not significantly improve prognosis beyond that offered by conservative treatment alone. Additional surgical decompression may not be necessary in patients with severe Bell’s palsy if they receive sufficient conservative treatment.
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Abstract
PURPOSE To analyze long-term outcomes in a large cohort of patients with acute peripheral facial palsy (APFP). METHODS Hospital-based, cross-sectional study. Data were abstracted from the electronic medical record. Time to recovery was assessed with Kaplan-Meier survival analyses. Binary logistic regression analysis was used to identify factors associated with outcome. RESULTS Three hundred seventy-two patients with APFP seen at a tertiary hospital between February 2015 and March 2021 were analyzed. Seasonal variation of APFP peaked in the early fall (September 29) and had a peak-to-low ratio of 1.36 (R2 = 0.329, p < 0.001). Patients who tested positive for Lyme disease (10%) had an earlier peak (July 16) compared with those who were negative (October 15). Eighty-seven percent of patients had complete recovery (averaging 64 ± 61 days). Patients, with higher House-Brackmann (H-B) grades at presentation took longer to recover, were more likely to have aberrant regeneration and had lower final rates of recovery compared with those with lower H-B grades (χ2 = 12.03, p < 0.001). Of the patients with residual palsies, 70% had evidence of aberrant regeneration, and nearly half of those had hemifacial spasm. CONCLUSIONS Most patients with APFP achieve complete recovery within 1 year, including those positive for Lyme. More severe palsy at presentation portends a worse outcome.
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Multidisciplinary Care of Patients with Facial Palsy: Treatment of 1220 Patients in a German Facial Nerve Center. J Clin Med 2022; 11:jcm11020427. [PMID: 35054119 PMCID: PMC8778429 DOI: 10.3390/jcm11020427] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
To determine treatment and outcome in a tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients referred between 2007 and 2018. Facial grading with the Stennert index, the Facial Clinimetric Evaluation (FaCE) scale, and the Facial Disability Index (FDI) were used for outcome evaluation; 1220 patients (58.4% female, median age: 50 years; chronic palsy: 42.8%) were included. Patients with acute and chronic facial palsy were treated in the center for a median of 3.6 months and 10.8 months, respectively. Dominant treatment in the acute phase was glucocorticoids ± acyclovir (47.2%), followed by a significant improvement of all outcome measures (p < 0.001). Facial EMG biofeedback training (21.3%) and botulinum toxin injections (11%) dominated the treatment in the chronic phase, all leading to highly significant improvements according to facial grading, FDI, and FaCE (p < 0.001). Upper eyelid weight (3.8%) and hypoglossal–facial-nerve jump suture (2.5%) were the leading surgical methods, followed by improvement of facial motor function (p < 0.001) and facial-specific quality of life (FDI, FaCE; p < 0.05). A standardized multidisciplinary team approach in a facial nerve center leads to improved facial and emotional function in patients with acute or chronic facial palsy.
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Principles and Guidelines of Immunotherapy in Neuromuscular Disorders. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00007-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Therapie der idiopathischen Fazialisparese („Bell’s palsy“). DGNEUROLOGIE 2022; 5. [PMCID: PMC9554855 DOI: 10.1007/s42451-022-00489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Saran S, Misra S, Kumar S, Rai N. Approach to new-onset facial nerve palsy in a critically ill patient: A case report. Int J Crit Illn Inj Sci 2022; 12:115-117. [PMID: 35845127 PMCID: PMC9285124 DOI: 10.4103/ijciis.ijciis_94_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
Lower motor type of facial nerve palsy (Bell's palsy) is one of the most common types of facial nerve palsy, with well-defined management with steroids and antivirals for patients attending outpatient clinics. The diagnosis and management of facial nerve palsy in critically ill patients require an individualized approach, as there may be many other causes like soft-tissue compression due to facial edema which can occur as a complication of prone ventilation and severe subcutaneous emphysema. This report highlights the challenges in the management of new-onset facial nerve palsy diagnosed in the intensive care unit (ICU) for a patient on mechanical ventilation, and creates a necessity for a standard operating protocol for the management of such scenarios in ICU.
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Thielker J, Kuttenreich AM, Volk GF, Guntinas-Lichius O. [Diagnostics and Therapy of Idiopathic Facial Palsy (Bell's Palsy)]. Laryngorhinootologie 2021; 100:1004-1018. [PMID: 34826861 DOI: 10.1055/a-1529-3582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this review is to report the knowledge for otolaryngologists on standard of care, latest advances, interesting new findings and controversies about the treatment of Bell's palsy. This review is focusing on the acute phase of the disease. The chronic phase, with incomplete, incorrect or no recovery of the palsy, is described briefly. Treatment with prednisolone alone within 72 hours after onset still is the cornerstone of the treatment. The role of antivirals still is unclear. Since 2009 no new and breakthrough clinical trials with influence on the treatment standards have been performed. A study to clarify the role of prednisolone treatment in children is ongoing. Patient-related outcome measures like the Facial Clinimetric Evaluation Scale and the Facial Disability Index are important tools to assess the subjective severity of the disease and psychosocial impact of Bell's palsy next to the motor deficits. Simplified subjective electronic grading systems like the eFACE and first automated image analysis systems have been introduced. Studies clarifying the role of antivirals for severe cases are urgently needed as well as studies on the role of salvage second line therapy after insufficient response to initial corticosteroid treatment. An international consensus on the outcome measures in diagnostics and follow-up is also needed.
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Affiliation(s)
| | | | | | - Orlando Guntinas-Lichius
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Universitätsklinikum Jena, Jena, Germany
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Wang Y, Cruz CD, Stern BJ. Approach to Facial Weakness. Semin Neurol 2021; 41:673-685. [PMID: 34826871 DOI: 10.1055/s-0041-1726358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Facial palsy is a common neurologic concern and is the most common cranial neuropathy. The facial nerve contains motor, parasympathetic, and special sensory functions. The most common form of facial palsy is idiopathic (Bell's palsy). A classic presentation requires no further diagnostic measures, and generally improves with a course of corticosteroid and antiviral therapy. If the presentation is atypical, or concerning features are present, additional studies such as brain imaging and cerebrospinal fluid analysis may be indicated. Many conditions may present with facial weakness, either in isolation or with other neurologic signs (e.g., multiple cranial neuropathies). The most important ones to recognize include infections (Ramsay-Hunt syndrome associated with herpes zoster oticus, Lyme neuroborreliosis, and complications of otitis media and mastoiditis), inflammatory (demyelination, sarcoidosis, Miller-Fisher variant of Guillain-Barré syndrome), and neoplastic. No matter the cause, individuals may be at risk for corneal injury, and, if so, should have appropriate eye protection. Synkinesis may be a bothersome residual phenomenon in some individuals, but it has a variety of treatment options including neuromuscular re-education and rehabilitation, botulinum toxin chemodenervation, and surgical intervention.
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Affiliation(s)
- Yujie Wang
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Camilo Diaz Cruz
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Barney J Stern
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
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Charoenlux P, Utoomprurkporn N, Seresirikachorn K. The efficacy of corticosteroid after facial nerve neurorrhaphy: a systematic review and meta-analysis of randomized controlled trial. Braz J Otorhinolaryngol 2021; 89:79-89. [PMID: 34815200 PMCID: PMC9874359 DOI: 10.1016/j.bjorl.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/26/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The benefit of corticosteroids following facial nerve neurorrhaphy in the setting of complete transection is questionable. This systematic review and meta-analysis aimed to evaluate corticosteroid efficacy on facial nerve regeneration and functional recovery after complete disruption and neurorrhaphy. METHODS Randomized controlled trials on both human and animal models from Ovid MEDLINE and Ovid EMBASE studying corticosteroid efficacy in complete facial nerve disruption followed by neurorrhaphy were included. Data were extracted and pooled for meta-analysis. The outcomes were evaluated from electrophysiology, histology, and functional recovery. However, no randomized controlled trial in human was performed. Possibly, performing human trials with histopathology may not be feasible in clinical setting. RESULTS Six animal studies (248 participants) met inclusion criteria. Electrophysiologic outcomes revealed no differences in latency (Standardized Mean Difference (SMD) = -1.97, 95% CI -7.38 to 3.44, p = 0.47) and amplitude (SMD = 0.37, 95% CI -0.44 to 1.18, p = 0.37) between systemic corticosteroids and controls. When analysis compared topical corticosteroid and control, the results provided no differences in latency (Mean Difference (MD) = 0.10, 95% CI -0.04 to 0.24, p = 0.16) and amplitude (SMD = 0.01, 95% CI -0.08 to 0.10, p = 0.81). In histologic outcomes, the results showed no differences in axon diameter (MD = 0.13, 95% CI -0.15 to 0.41, p = 0.37) between systemic corticosteroid and control; however, the result in myelin thickness (MD = 0.06, 95% CI 0.04 to 0.08, p < 0.05) favored control group. When comparing systemic corticosteroid with control in eye blinking, the results favored control (MD = 1.33, 95% CI 0.60 to 2.06, p = 0.0004). CONCLUSIONS This evidence did not show potential benefits of systemic or topical corticosteroid deliveries after facial nerve neurorrhaphy in complete transection when evaluating electrophysiologic, histologic, and functional recovery outcomes in animal models.
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Affiliation(s)
- Prapitphan Charoenlux
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nattawan Utoomprurkporn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,UCL Ear Institute, Faculty of Brain Science, University College London, London, United Kingdom
| | - Kachorn Seresirikachorn
- Department of Otolaryngology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,Endoscopic Nasal and Sinus Surgery Excellence Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand,Corresponding author.
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Kim Y, Doo JG, Chon J, Lee JH, Jung J, Lee JM, Kim SH, Yeo SG. Steroids plus antiviral agents are more effective than steroids alone in the treatment of severe Bell's palsy patients over 40 years of age. Int J Immunopathol Pharmacol 2021; 35:20587384211042124. [PMID: 34633253 PMCID: PMC8511921 DOI: 10.1177/20587384211042124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective The effectiveness of the combination of steroids and antiviral agents in the
treatment of Bell’s palsy remains unclear. This study evaluated the
therapeutic effect of combination therapy in severe Bell’s palsy patients
and assesses specific conditions under which combination therapy is more
effective than steroids alone. Methods From January 2005 to December 2019, the records of 1710 Bell’s palsy patients
who visited Kyung Hee University Hospital were reviewed retrospectively. Of
these, 335 (19.6%) patients were diagnosed with severe Bell’s palsy, with
162 patients treated with steroids alone and 173 patients treated with
combinations of steroids and antiviral agents. The outcomes of treatment
were assessed using the House–Brackmann (H-B) grade according to age, sex,
hypertension, diabetes, and obesity. Results The favorable recovery rate was significantly higher in severe Bell’s palsy
patients who were treated with combinations of steroids and antiviral agents
than with steroids alone (78.0% vs. 66.7%, p = 0.020).
Subgroup analysis showed that combination therapy resulted in significantly
higher recovery rates than steroids alone in patients aged ≥40 years (77.5%
vs. 64.1%, p = 0.023) and in those without hypertension
(75.8% vs. 63.3%, p = 0.044) and diabetes (79.7% vs. 65.5%,
p = 0.007). Conclusion Combination therapy with steroids and antiviral agents resulted in
significantly higher favorable recovery rates than steroids alone in severe
Bell’s palsy patients. Combination therapy was particularly more effective
than steroids alone in patients aged ≥40 years and in patients without
hypertension and diabetes.
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Affiliation(s)
- Yong Kim
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jeon Gang Doo
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jinmann Chon
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jong Ha Lee
- Department of Rehabilitation Medicine, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Junyang Jung
- Department of Anatomy and Neurobiology, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Jae Min Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Sang Hoon Kim
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, 26723Kyung Hee University, Seoul, Republic of Korea
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Clinical Prognostic Factors Associated with Good Outcomes in Pediatric Bell's Palsy. J Clin Med 2021; 10:jcm10194368. [PMID: 34640384 PMCID: PMC8509832 DOI: 10.3390/jcm10194368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/30/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
The prognosis of children with Bell’s palsy remains unclear due to its relatively low incidence, and thus, the small number of patients included in individual studies. To evaluate the prognosis of children with Bell’s palsy and identify the predictive value of specific factors that contribute to complete recovery, a retrospective cohort study was conducted of all patients with Bell’s palsy who visited the outpatient clinic of our university hospital between January 2005 and December 2020. We identified the parameters associated with a favorable recovery after 6 months in pediatric patients with Bell’s palsy. Factors recorded for each patient included age, sex, side affected by palsy, time between symptom onset and start of treatment, treatment methods, and the House–Brackmann grade (H–B) grade. The results of the multivariable analysis revealed that the lower degree of initial facial nerve paralysis presented as H–B grade II–IV was a significant favorable prognostic factor (OR: 3.86; 95% CI: 1.27–11.70; p < 0.05). Our results showed that the most important factor influencing the complete recovery of Bell’s palsy in children was the lower initial H–B grade at initial presentation.
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