The effect of metabolic syndrome on Bell's palsy recovery rate

Delayed repair of the facial nerve and its negative impacts on nerve and muscle regeneration

Background

In this experimental protocol, we evaluated the immediate and delayed repair of the buccal branch of the facial nerve (BBFN) with heterologous fibrin biopolymer (HFB) as a coaptation medium and the use of photobiomodulation (PBM), performing functional and histomorphometric analysis of the BBFN and perioral muscles.

Methods

Twenty-eight rats were divided into eight groups using the BBFN bilaterally (the left nerve was used for PBM), namely: G1 - control group, right BBFN (without injury); G2 - control group, left BBFN (without injury + PBM); G3 - Denervated right BBFN (neurotmesis); G4 - Denervated left BBFN (neurotmesis + PBM); G5 - Immediate repair of right BBFN (neurotmesis + HFB); G6 - Immediate repair of left BBFN (neurotmesis + HFB + PBM); G7 - Delayed repair of right BBFN (neurotmesis + HFB); G8 - Delayed repair of left BBFN (neurotmesis + HFB + PBM). Delayed repair occurred after two weeks of denervation. All animals were sacrificed after six weeks postoperatively.

Results

In the parameters of the BBFN, we observed inferior results in the groups with delayed repair, in relation to the groups with immediate repair, with a significant difference (p < 0.05) in the diameter of the nerve fiber, the axon, and the thickness of the myelin sheath of the group with immediate repair with PBM compared to the other experimental groups. In measuring the muscle fiber area, groups G7 (826.4 ± 69.90) and G8 (836.7 ± 96.44) were similar to G5 (882.8 ± 70.51). In the functional analysis, the G7 (4.10 ± 0.07) and G8 (4.12 ± 0.08) groups presented normal parameters.

Conclusion

We demonstrated that delayed repair of BBFN is possible with HFB, but with worse results compared to immediate repair, and that PBM has a positive influence on nerve regeneration results in immediate repair.

Association between Bell's Palsy and Cardiometabolic Risks: An Age- and Sex-Matched Case-Control Study

BACKGROUND

Bell's palsy is possibly an ischemic cranial neuropathy, although reactivation of herpes virus infection has been proposed.

METHODS

This was an age-and sex-matched and 1:2 case-control study enrolling Bell's palsy patients during 2011-2021 in a university hospital to investigate the significant associations of cardiometabolic risks (CMRs) with Bell's palsy. We analyzed the differences in waist circumference (WC), body mass index (BMI), systolic and diastolic blood pressures (SBP and DBP), fasting blood sugar (FBS), and lipid levels at 12 weeks post-Bell's palsy with those of the controls by descriptive statistics (p < 0.05). The differences in means or medians of individual CMR values across the consecutive 10-year age intervals were analyzed by ANOVA F-tests and Kruskal-Wallis tests (p < 0.05).

RESULTS

A total of 140 cases and 280 controls were enrolled. Bell's palsy patients had significantly higher WC, BMI, SBP, DBP, FBS, and triglyceride but lower high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Moreover, high WC, elevated FBS (≥100 mg/dL), SBP (≥130 mmHg), and total cholesterol were significantly associated with Bell's palsy cases by multivariable analysis. Only FBS in Bell's palsy patients significantly elevated across consecutive 10-year age intervals.

CONCLUSION

Screening and monitoring for CMRs, especially hyperglycemia, in every patient presenting with Bell's palsy is essential despite initial normoglycemia, particularly in older-onset cases.

Association of Influenza Vaccination With Risk of Bell Palsy Among Older Adults in Taiwan

Importance

Annual administration of the influenza vaccine (fluVc) is currently the most effective method of preventing the influenza virus in older adults. However, half of adults older than 65 years remain unvaccinated in Taiwan, possibly because of concern about adverse events, such as Bell palsy (BP). Currently, studies on the association between fluVc and risk of BP are inconsistent.

Objective

To determine whether the incidence of BP increases following fluVc in older adults.

Design, Setting, and Participants

A self-controlled case series study design was used. Days 1 through 7, days 8 through 14, days 15 through 30, and days 31 through 60 following fluVc were identified as risk intervals, and days 61 through 180 were considered the control interval. A total of 4367 vaccinated individuals aged 65 years or older who developed BP within 6 months following fluVc were enrolled. Population-based retrospective claims data were obtained between 2010 and 2017; data were analyzed from April 2022 through September 2022.

Exposure

Government-funded seasonal fluVc.

Main Outcomes and Measures

The outcome of interest was BP onset in risk intervals compared with control intervals. Three or more consecutive diagnoses of BP within 60 days following fluVc were used as the definition of a patient with BP. Poisson regression was used to analyze the incidence rate ratio (IRR) of risk intervals compared with control intervals.

Results

In total, 13 261 521 patients who received the fluVc were extracted from the National Health Insurance Research Database in Taiwan from January 1, 2010, to December 31, 2017. Of those, 7 581 205 patients older than 65 years old met the inclusion criteria. The number of patients with BP diagnosed within 6 months following fluVc enrolled for risk analysis was 4367 (mean [SD] age, 74.19 [5.97] years; 2349 [53.79%] female patients). The incidence rate of BP among all observed fluVc older adults was 57.87 per 100 000 person-years. The IRRs for BP on days 1 through 7, days 8 through 14, and days 15 through 30 were 4.18 (95% CI, 3.82-4.59), 2.73 (95% CI, 2.45-3.05), and 1.67 (95% CI, 1.52-1.84), respectively. However, there was no increase during days 31 through 60 (IRR, 1.06; 95% CI, 0.97-1.16). The postvaccination risk of BP was consistent across all subgroups stratified by sex, age group, and baseline conditions.

Conclusions and Relevance

The present self-controlled case series indicated that the risk of BP in individuals older than 65 years increased within the first month, especially within the first week, following fluVc. But overall, the adverse event rate of BP was low, and considering the morbidity and mortality of influenza infection, the benefits of fluVc still outweigh the risks.

Morphofunctional Improvement of the Facial Nerve and Muscles with Repair Using Heterologous Fibrin Biopolymer and Photobiomodulation

Peripheral nerve injuries impair the patient's functional capacity, including those occurring in the facial nerve, which require effective medical treatment. Thus, we investigated the use of heterologous fibrin biopolymer (HFB) in the repair of the buccal branch of the facial nerve (BBFN) associated with photobiomodulation (PBM), using a low-level laser (LLLT), analyzing the effects on axons, muscles facials, and functional recovery. This experimental study used twenty-one rats randomly divided into three groups of seven animals, using the BBFN bilaterally (the left nerve was used for LLLT): Control group-normal and laser (CGn and CGl); Denervated group-normal and laser (DGn and DGl); Experimental Repair Group-normal and laser (ERGn and ERGl). The photobiomodulation protocol began in the immediate postoperative period and continued for 5 weeks with a weekly application. After 6 weeks of the experiment, the BBFN and the perioral muscles were collected. A significant difference (p < 0.05) was observed in nerve fiber diameter (7.10 ± 0.25 µm and 8.00 ± 0.36 µm, respectively) and axon diameter (3.31 ± 0.19 µm and 4.07 ± 0.27 µm, respectively) between ERGn and ERGl. In the area of muscle fibers, ERGl was similar to GC. In the functional analysis, the ERGn and the ERGI (4.38 ± 0.10) and the ERGI (4.56 ± 0.11) showed parameters of normality. We show that HFB and PBM had positive effects on the morphological and functional stimulation of the buccal branch of the facial nerve, being an alternative and favorable for the regeneration of severe injuries.

Effect of Facial Chuna Manual Therapy Combined with Korean Medicine Treatmeant for Bell’s Palsy

The effect of combined Korean medicine treatment including facial chuna manual therapy was retrospectively investigated in patients with Bell’s palsy. There were 16 patients (14 males) who received 2 months outpatient treatment following > 14 days of hospitalization. The Yanagihara score and House- Brackmann grade were used to measure the severity of symptoms and recovery. The patients (mean age 58.5 ± 24.74 years) were categorized based on their medical history of hypertension (n = 10), diabetes millitus (n = 10), or oral intake of steroids early in the diagnosis of Bell’s palsy (n = 10). There was no difference between patients who had or did not have a previous history of diabetes mellitus or oral steroid. Both the Yanagihara-score and House-Brackmann grade improved significantly in the total patient sample after treatment (p < 0.001). Combined Korean medicine including facial chuna manual therapy may have a beneficial effect on patient symptoms and recovery.

Role of Biomarkers as Prognostic Factors in Acute Peripheral Facial Palsy

Acute peripheral facial palsy (APFP), including Bell's palsy and Ramsay Hunt syndrome, is a disease that affects daily life through facial motor dysfunction, causing psychological problems. Various tests to evaluate prognosis have been studied; however, there are no validated predictive biomarkers to guide clinical decision making. Therefore, specific biomarkers that respond to treatment are required to understand prognostic outcomes. In this review, we discuss existing literature regarding the role of APFP biomarkers in prognosis and recovery. We searched the PubMed, EMBASE, and Cochrane Library databases for relevant papers. Our screening identified relevant studies and biomarkers correlating with the identification of predictive biomarkers. Only studies published between January 2000 and October 2021 were included. Our search identified 5835 abstracts, of which 35 were selected. All biomarker samples were obtained from blood and were used in the evaluation of disease severity and prognosis associated with recovery. These biomarkers have been effective prognostic or predictive factors under various conditions. Finally, we classified them into five categories. There is no consensus in the literature on the correlation between outcomes and prognostic factors for APFP. Furthermore, the correlation between hematologic laboratory values and APFP prognosis remains unclear. However, it is important to identify new methods for improving the accuracy of facial paralysis prognosis prediction. Therefore, we systematically evaluated prognostic and potentially predictive APFP biomarkers. Unfortunately, a predictive biomarker validating APFP prognosis remains unknown. More prospective studies are required to reveal and identify promising biomarkers providing accurate prognosis.

Risk factors for Bell's palsy based on the Korean National Health Insurance Service National Sample Cohort data

The associations between hypertension, diabetes, and dyslipidemia with Bell's palsy have been controversial and only a few studies have assessed risk factors for Bell's palsy based on population-based data. The aim of the present study was to evaluate whether sociodemographic factors such as sex, age, residence, household income, and metabolic diseases such as hypertension, diabetes, and dyslipidemia were risk factors for Bell's palsy using the National Health Insurance Service National Sample Cohort data of Korea. Patients who visited an outpatient clinic twice or more or had one or more admission and received steroid medication under the International Classification of Diseases diagnostic codes for Bell's palsy from 2006 to 2015 were defined as patients with Bell's palsy in this study. The associations between sociodemographic factors and metabolic diseases to Bell's palsy were analyzed with univariate and multivariate Cox proportional hazard regression models. There were 2708 patients with Bell's palsy recorded from 2006 to 2015. Male sex, advanced age, residence in a location other than the capital and metropolitan cities, hypertension, and diabetes were significant risk factors for Bell's palsy. This study is significant for patients and providers because we analyzed the relationships using a population-based database over a long-term follow-up period.

A bibliometric analysis of research on the treatment of facial nerve palsy

BACKGROUND

There are various treatments for facial nerve palsy, and research into this topic is ongoing. In the present study, we carried out bibliometric and visualized analyses to identify the trends of research into facial nerve palsy treatment.

METHODS

To identify articles, the SCOPUS database was searched for articles published from its inception to December 27, 2020. The search was conducted twice, with Search 1 investigating general treatment trends and Search 2 narrowing the scope to complementary and alternative treatment. The extracted keywords were analyzed using the Visualization Of Similarities (VOS) viewer. Through analysis of keywords, research hotspots in the treatment of facial nerve palsy were identified.

RESULTS

A total of 1609 and 223 articles were identified in Searches 1 and 2, respectively. The number of articles published each year showed a tendency to increase, and most of the studies were only conducted in a few countries. In terms of subject area, "medicine" was overwhelmingly the most common(77.6%). Based on the analysis of 316 keywords in Search1, "medication treatment," and "complementary and alternative treatment" were the hotspots of research.

CONCLUSION

This study provides the overall trends of facial nerve palsy treatment. To date, research on medication treatment has been main focus, and antiviral use among medication treatment and complementary and alternative treatment has emerged in recent years.

Evaluation of Effects of Diabetes Mellitus, Hypercholesterolemia and Hypertension on Bell's Palsy

The aim of this study is to evaluate the effects of diabetes mellitus, hypertension and hypercholesterolemia on the clinical presentation and outcome of Bell’s palsy. The study (comorbidity) group consisted of 50 patients with Bell’s palsy associated with diabetes, hypertension, or hypercholesterolemia; the control group included 46 patients with Bell’s palsy, but without comorbid diseases. The House–Brackmann grading system (I to VI) was used in order to assess the initial and final facial functions. Both groups of patients were treated with steroids and the antiviral agent acyclovir. The mean severity of initial facial paralysis was more significant in diabetes, hypercholesterolemia, and hypertension, in comparison to the control group. Patients suffering from Bell’s palsy and concomitant comorbidities have a poorer prognosis (HB III-VI) compared to patients without comorbidities. Increased glycosylated hemoglobin A1c levels (>6.7%) were significantly correlated with unsatisfactory facial recovery. The pathogenetic mechanisms by which diabetes, hypercholesterolemia, and hypertension affect the vasa nervosum of facial nerve have been described.

Bell’s palsy: clinical and neurophysiologic predictors of recovery

Background

The annual incidence of Bell’s palsy (BP) is 15 to 20 per 100,000 with 40,000 new cases each year, and the lifetime risk is 1 in 60. For decades, clinicians have searched the prognostic tests of sufficient accuracy for acute facial paralysis.

Objective

The present study was designed to verify in BP which clinical or electrophysiological parameters could be considered as predictive of the degree of recovery of normal facial muscle function.

Methods

Sixty-three patients with BP were initially assessed according to the House and Brackmann facial function scoring system “HB system”. All patients were followed for 3 months, the functional recovery then reassessed according to HB system. Nerve conduction studies were measured on the affected side via a bipolar surface stimulator placed over the stylomastoid foramen.

Results

We could not find statistically significant differences between BP with good and poor prognosis as regard age, sex, onset, diabetes, hypertension, dyslipidemia, or the initial HB Score. Compound motor action potential amplitude (CMAP) detected during the initial electroneurography (ENoG) was statistically significant between BP with good and poor prognosis.

Conclusions

The initial ENoG is more predictive of recovery of Bell’s palsy than the initial clinical grading using the HB system. Age, sex, hypertension, diabetes, and dyslipidemia do not seem to correlate with the degree of recovery in Bell’s palsy.

The Influence of Metabolic Syndrome on the Prognosis of Idiopathic Sudden Sensorineural Hearing Loss

OBJECTIVES

We aimed to verify the hypothesis that metabolic syndrome (MetS) and its components affect the prognosis of idiopathic sudden sensorineural hearing loss (ISNNHL).

STUDY DESIGN

A retrospective cohort study.

SETTING

Tertiary otology referral center.

PATIENTS

We divided patients who were diagnosed with ISSNHL between January 2015 and January 2018 into a MetS group and a Non-MetS group according to the diagnostic criteria of MetS.

INTERVENTIONS

We diagnosed ISSNHL patients by using pure-tone audiometry and treated them with oral steroids, blood flow promoting agents, and hyperbaric oxygen therapy.

MAIN OUTCOME MEASURES

We used multivariate logistic analysis to identify prognostic factors of ISSNHL.

RESULTS

The MetS group comprised 94 patients, and the Non-MetS group comprised 162 subjects. Despite the rate of hypertension, diabetes mellitus, hyperlipidemia, and BMI, no significant difference was observed between the two groups (p > 0.05). The rates of complete recovery and partial recovery of the MetS group were significantly lower than those of the Non-MetS group (p < 0.05). According to the multivariate analysis, MetS was significantly correlated with a poor prognosis (OR = 2.912, p = 0.008), and the OR increased with an increase in the number of MetS components. Late onset of treatment, high initial hearing threshold, and presence of diabetes mellitus and hyperlipidemia were associated with a poor prognosis (p < 0.05).

CONCLUSIONS

The presence of MetS may negatively affect the recovery of Chinese patients with ISSNHL, and the prognosis was poorer with an increase in the number of MetS components. Early onset of treatment, low initial hearing threshold and absence of diabetes mellitus, and hyperlipidemia are associated with favorable hearing recovery.

Bell's palsy and obesity, alcohol consumption and smoking: A nested case-control study using a national health screening cohort

The aim of this study was to investigate the association of body mass index (BMI), alcohol consumption, and smoking status with the occurrence of Bell’s palsy. The Korean National Health Insurance Service-Health Screening Cohort of a ≥ 40-year-old population from 2000–2003 was used. A total of 5,632 Bell’s palsy participants were matched with 22,528 control participants in terms of age, sex, income, region of residence, and past medical histories of hypertension, diabetes, and dyslipidemia. Bell’s palsy was classified by a history of ≥2 diagnoses with ICD-10 code (G510) and steroid treatment. BMI (kg/m²) was classified as <18.5 (underweight), ≥18.5 to <23 (normal), ≥23 to <25 (overweight), ≥25 to <30 (obese I), and ≥30 (obese II). Alcohol consumption was divided into non-drinkers and those who drank 2–3 times a month, 1–2 times a week, and ≥3 times a week. Smoking status was categorized as current smokers, past smokers, and non-smokers. The odds of obesity, alcohol consumption, and smoking with Bell’s palsy were analyzed using logistic regression analysis. BMI showed proportionally positive associations with Bell’s palsy (adjusted OR [95% CI] = 0.61 [0.47–0.79] for underweight, 1.16 [1.08–1.26] for normal, 1.24 [1.15–1.33] for obese I, and 1.61 [1.38–1.88] for obese II, P < 0.001). The odds of alcohol consumption with Bell’s palsy were 0.90 (95% confidence interval [CI] = 0.82–0.99) for 2–3 times a month, 0.77 (95% CI = 0.69–0.85) for 1–2 times a week, and 0.79 (95% CI = 0.71–0.88) for ≥3 times a week compared to nondrinkers (P < 0.001). Smoking did not show a relationship with the occurrence of Bell’s palsy. Obesity was related to the risk of Bell’s palsy in the population over 40 years old. On the other hand, alcohol consumption was negatively associated with the occurrence of Bell’s palsy.

Association of Patients' Characteristics with Acupuncture Treatment Outcomes in Treating Bell's Palsy: Results from a Randomised Controlled Trial

Background

Acupuncture has been found to be effective for treating Bell's palsy (BP). However, which class of BP patients will have a better response to acupuncture remains uncertain and requires investigation.

Methods

We performed a secondary analysis of a multicenter, randomized, controlled trial. BP patients were randomly divided into five acupuncture treatment groups. The degree of facial nerve recovery was assessed according to the House–Brackmann grading system (HB grade). Grade I was defined as complete recovery (CR), and grades II–VI were defined as incomplete recovery (IR). The relevant patient characteristics were collected and compared between CR and IR groups by univariate and logistic regression analyses.

Results

Eight-hundred twenty-six subjects were analyzed. Among these, 698 (85%) subjects had a good prognosis. No significant difference in the effectiveness of the five treatments was observed (all P > 0.05). The likelihood of IR increased by 2.2% with each one-year increase in age (odds ratio (OR) 1.022, 95% confidence interval (CI) 1.005–1.038; P=0.009). The likelihood of IR increased by 9% with each kg/m2 increase in BMI (OR 1.090, 95% CI 1.019–1.165; P=0.012). The likelihood of IR at the recovery stage was higher than that at the acute stage (OR 7.996, 95% CI 4.570–13.991; P < 0.001), and the likelihood of IR of patients with lesions at or above the chorda tympani was higher than that of patients with lesions below the chorda tympani (OR 1.989, 95% CI 1.256–3.150; P=0.003). The likelihood of IR increased by 281.7% with each unit increase in the HB grade (OR 2.817, 95% CI 2.113–3.756; P < 0.001).

Conclusions

Younger patients at the acute stage of the disease with low BMIs, low initial HB grades, and lesions below the chorda tympani were more likely to respond to acupuncture.

Impact of metabolic syndrome on recovery of idiopathic sudden sensorineural hearing loss

PURPOSE

Metabolic syndrome (MetS) was reported to a risk factor of developing idiopathic sudden sensorineural hearing loss (ISSNHL), but limited data exist on its effect on the recovery. The purpose of this study was to evaluate the impact of (MetS) and its components on recovery of patients with ISSNHL.

MATERIAL AND METHODS

228 ISSNHL patients were divided into MetS group and Non-MetS group according to the diagnostic criteria of MetS, and demographic and clinical characteristics and hearing recovery were reviewed between two groups.

RESULTS

In total, 86 (37.7%) patients in MetS group, and 142 (62.3%) patients in Non-MetS group. The rate of hypertension, diabetes mellitus, low HDL-C, high TG and obesity were significantly higher in the MetS group than those in the Non-MetS group (P < 0.05). The complete recovery rate and partial recovery rate were significantly lower in the MetS group than those in the Non-MetS group. According to the multivariate analysis, MetS was significantly associated with a poor prognosis; high initial hearing threshold and presence of diabetes mellitus were correlated with a poor prognosis (P < 0.05).

CONCLUSIONS

These results suggest that MetS has a negative impact on the hearing recovery of ISSNHL. High initial hearing threshold and diabetes mellitus were indictors of a poor prognosis of ISSNHL.

Comparative prognosis in patients with Ramsay-Hunt syndrome and Bell's palsy

PURPOSE

Patients with Ramsay-Hunt syndrome have a poorer prognosis than patients with Bell's palsy. Factors of metabolic syndrome affecting prognosis were therefore compared between patients with Ramsay-Hunt syndrome and those with Bell's palsy.

METHODS

This retrospective study included 106 with Ramsay-Hunt syndrome and 182 with Bell's palsy. Age, sex, body mass index, blood pressure, blood test results, and ENoG results, stratified by House-Brackmann grade, were compared in patients with Ramsay-Hunt syndrome and Bell's palsy. Both groups of patients were treated with steroids and the antiviral agent famciclovir.

RESULTS

Age, sex, body mass index, dyslipidemia, triglyceride, diabetes, hypertension, and onset of palsy did not differ in patients with Ramsay-Hunt syndrome and Bell's palsy. Rates of favorable recovery in patients with severe facial palsy and DM were lower in patients with Ramsay-Hunt syndrome than with Bell's palsy and were also lower in low-weight, normal weight, and overweight patients with Ramsay-Hunt syndrome than with Bell's palsy. Rates of favorable recovery in patients with severe facial palsy and normal HDL, as well as in patients with severe facial palsy and < 10% ENoG, were lower in patients with Ramsay-Hunt syndrome than with Bell's palsy.

CONCLUSIONS

Among patients with severe facial palsy, along with diabetes and < 10% ENoG, unfavorable recovery rates were significantly higher in those with Ramsay-Hunt syndrome than with Bell's palsy.