1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Frutos-Reoyo EJ, López-Izquierdo R, Luque-Linero P, Cantalapiedra-Puentes E, Antón-Andrés MJ, Hernández-Gajate JM, Candau-Pérez ED. Analysis of Predictive Factors for the Poor Prognosis of Peripheral Facial Paralysis. Am J Phys Med Rehabil 2024; 103:245-250. [PMID: 37602548 DOI: 10.1097/phm.0000000000002328] [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: 08/22/2023]
Abstract
PURPOSE The aim of the study is to evaluate the predictive factors for a poor prognosis in patients with facial paralysis evaluated in the rehabilitation department of a tertiary hospital. METHODS We have conducted a prospective cohort study. Patients who required elective botulinum toxin infiltration, surgical treatment, or follow-up appointments longer than 6 months due to incomplete recovery were considered to have a poor prognosis. Descriptive and analytical analyses of clinical and epidemiological variables were performed. The follow-up period was 6 mos. RESULTS A total of 47 adult patients were analyzed, 54.2% of whom were women. The mean age was 53.2 yrs (SD, 15.5 yrs). Twenty-five percent had an unfavorable prognosis. A statistically significant association with prognosis was observed for neurophysiological results and the scores of the House-Brackmann scale and the Sunnybrook Facial Grading System. CONCLUSIONS Neurophysiological tests are especially useful when evaluating prognosis. Likewise, Sunnybrook Facial Grading System is a useful and accessible tool with prognostic value, especially within a month of initial diagnosis, when a score lower than 65 indicates a poor prognosis with high sensitivity and specificity. These tools can be especially useful to reduce the clinical and psychological impact and to provide patients with early therapeutic management.
Collapse
Affiliation(s)
- Emilio Javier Frutos-Reoyo
- From the Servicio de Medicina Física y Rehabilitación, Hospital Universitario Río Hortega, Valladolid, Spain (EJF-R, EC-P, MJA-A, EDC-P); Servicio de Urgencias, Hospital Universitario Río Hortega, Valladolid, Spain (RL-I, JMH-G); Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain (PL-L); Servicio de Medicina Física y Rehabilitación, Hospital Virgen de la Concha, Zamora, Spain (EC-P)
| | | | | | | | | | | | | |
Collapse
|
4
|
Nakano H, Fujiwara T, Tsujimoto Y, Morishima N, Kasahara T, Ameya M, Tachibana K, Sanada S, Toufukuji S, Hato N. Physical therapy for peripheral facial palsy: A systematic review and meta-analysis. Auris Nasus Larynx 2024; 51:154-160. [PMID: 37149416 DOI: 10.1016/j.anl.2023.04.007] [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: 02/01/2023] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE This study aimed to reveal the efficacy of physical therapy for patients with peripheral facial palsy. METHODS A literature search was conducted using PubMed, Ichushi-Web, and Cochrane Central Register of Controlled Trials. Published randomized controlled trials comparing the physical therapy versus placebo/non-treatment for peripheral facial palsy such as Bell's palsy, Ramsay Hunt syndrome, and traumatic facial palsy were included for meta-analysis. The primary outcome was non-recovery at the end of the follow-up. Non-recovery was defined according to the authors' definition. The secondary outcomes were the composite score of the Sunnybrook facial grading system and sequelae (presence of synkinesis or hemifacial spasm) at the end of the follow-up. Data was analyzed using Review Manager software and pooled risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) were calculated. RESULTS Seven randomized controlled trials met the eligible criteria. The data on non-recovery from four studies was obtained and included 418 participants in the meta-analysis. Physical therapy might reduce non-recovery (RR = 0.51 [95% CI = 0.31-0.83], low quality). Pooling the data of composite score of the Sunnybrook facial grading system from three studies (166 participants) revealed that physical therapy might increase the composite scores (MD = 12.1 [95% CI = 3.11-21.0], low quality). Moreover, we obtained data on sequelae from two articles (179 participants). The evidence was very uncertain about the effect of physical therapy on reduction of sequelae (RR = 0.64 [95% CI = 0.07-5.95], very low quality). CONCLUSION The evidence suggested that physical therapy reduces non-recovery in patients with peripheral facial palsy and improves the composite score of the Sunnybrook facial grading system, whereas the efficacy of physical therapy in reducing sequelae remained uncertain. The included studies had high risk of bias, imprecision, or inconsistency; therefore, the certainty of evidence was low or very low. Further well-designed randomized controlled trials are needed to confirm its efficacy.
Collapse
Affiliation(s)
- Haruki Nakano
- Department of Physical and Rehabilitation Medicine, Division of Comprehensive Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Takashi Fujiwara
- Department of Otolaryngology Head and Neck Surgery, Kurashiki Central Hospital, Miwa 1-1-1, Kurashiki city, Okayama, 710-8602, Japan
| | - Yasushi Tsujimoto
- Oku Medical Clinic, Shinmori 7-1-4, Asahi-ku, Osaka city, Osaka, 535-0022, Japan; Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Naohito Morishima
- Department of Rehabilitation, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takashi Kasahara
- Department of Rehabilitaion Medicine, Tokai University School of Medicine, 143, Shimokasuya, Isehara, Kanagawa 259-1193, Japan
| | - Misato Ameya
- Department of Otolaryngology, Head and Neck Surgery, Ehime University School of Medicine, Toon, Japan
| | - Keita Tachibana
- Department of Central Rehabilitation Medicine, Osaka Rosai Hospital, Sakai, Japan
| | - Shota Sanada
- Department of Rehabilitation, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Saori Toufukuji
- Department of Rehabilitation Services, Tokai University Hospital, 143 Shimokasuya, Isehara-shi, Kanagawa 259-1193, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| |
Collapse
|
5
|
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.
Collapse
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.)
| |
Collapse
|
6
|
Characteristics and Treatment Methods of Bell’s Palsy in Patients Visiting Korean Medicine Hospitals From August 2018 to July 2021. JOURNAL OF ACUPUNCTURE RESEARCH 2022. [DOI: 10.13045/jar.2022.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: This study was designed to statistically analyze the data of patients who had Bell’s palsy (BP) who visited a Korean Medicine hospital in the last 3 years to determine the tendency or characteristics of their visit.Methods: This study retrospectively analyzed the medical records of 816 patients. Based on the data collected through medical records demographics, condition/disease, and therapeutic characteristics of the patients were analyzed using IBM SPSS Version 23.0.Results: Patients in their teens or younger, and 50s or older had a higher frequency of inpatient treatment, and 20s to 40s had a higher rate of outpatient treatment. The proportion of men who received steroid combination treatment was higher than women. The number of patients with BP, and the total treatment period of the patients has decreased every year. The total treatment period was shorter in the steroid group than the Korean medicine alone group. Inpatients were more likely to receive steroid combination therapy than outpatients. The proportion of patients who received steroid combination therapy was higher than patients with recurrence of BP. Patients with hypertension or diabetes had a higher rate of hospitalization and received more treatments than patients without the condition/disease.Conclusion: Visit characteristics and treatment methods preferred by patients with BP were identified. This research may help to establish a treatment model for BP in Korean Medicine institutions in the future.
Collapse
|
7
|
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.
Collapse
|
8
|
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]
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Kimura T, Yamada H, Teraoka M, Joko T, Iwata S, Tabata Y, Wakisaka H, Hato N. Intratympanic Insulin-like Growth Factor-1 Administration Via the Otic Bulla in a Severe Facial Paralysis Model. Otol Neurotol 2021; 42:e1376-e1381. [PMID: 34224549 DOI: 10.1097/mao.0000000000003263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS We investigated the treatment effect of intratympanic insulin-like growth factor-1 (IGF-1) on severe facial paralysis in guinea pigs. BACKGROUND The use of regenerative medicine involving growth factors has been reported in the treatment of peripheral nerve diseases. IGF-1 plays a crucial role in nerve regeneration. METHODS We performed the following procedures on guinea pigs. In the normal group (n = 7), no procedure was performed. In the saline (n = 7) and IGF-1 (n = 7) groups, facial paralysis was induced by freezing of the facial canal. Subsequently, in the saline and IGF-1 groups, a gelatin hydrogel impregnated with 100 μL saline and 400 μg/100 μL IGF-1, respectively, was placed in the facial canal. Facial nerve functions were evaluated using three test batteries: facial movement observation, electrophysiological testing, and histological assessment. RESULTS At 10 weeks postoperatively, the facial movement scores for the IGF-1 group were improved compared to those in the saline group. The conductive velocity was significantly faster in the IGF-1 group than in the saline group. There was a significant between-group difference in the nerve fiber number and myelin thickness. CONCLUSION Intratympanic IGF-1 administration improved facial nerve regeneration. This novel method could provide prompt ambulatory regenerative treatment and reduce the incidence of poor recovery in patients with severe facial paralysis.
Collapse
Affiliation(s)
- Takuya Kimura
- Department of Otorhinolaryngology Head and Neck Surgery, Ehime University
| | - Hiroyuki Yamada
- Department of Otorhinolaryngology Head and Neck Surgery, Ehime University
| | - Masato Teraoka
- Department of Otorhinolaryngology Head and Neck Surgery, Ehime University
| | - Tomonori Joko
- Department of Otorhinolaryngology Head and Neck Surgery, Ehime University
| | - Shinji Iwata
- Department of Otorhinolaryngology Head and Neck Surgery, Ehime University
| | - Yasuhiro Tabata
- Laboratory of Biomaterials, Department of Regeneration Science and Engineering Institute for Frontier Life and Medical Sciences, Kyoto University
| | - Hiroyuki Wakisaka
- Laboratory of Head and Neck Surgery, Ehime Prefectural University of Health Sciences, Ehime, Japan
| | - Naohito Hato
- Department of Otorhinolaryngology Head and Neck Surgery, Ehime University
| |
Collapse
|
11
|
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.
Collapse
|
12
|
Yoo MC, Park DC, Yeo SG. Association between Initial Severity of Facial Weakness and Outcomes of Bell's Palsy. J Clin Med 2021; 10:3914. [PMID: 34501363 PMCID: PMC8432204 DOI: 10.3390/jcm10173914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/19/2021] [Accepted: 08/29/2021] [Indexed: 12/01/2022] Open
Abstract
To establish whether clinical prognostic factor outcomes differed based on the initial severity of facial weakness and to determine the association between the initial severity of facial weakness and favorable outcomes. This retrospective cohort study analyzed all patients with Bell's palsy who visited the outpatient clinic of our university hospital from 1 January 2005 through 31 January 2021. The primary outcome was the rate of recovery at 6 months, evaluated separately in patients with initial House-Brackmann (H-B) grades 3-4 and 5-6. Secondary outcomes included clinical factors associated with favorable outcomes stratified by the initial H-B grade. The rate of favorable recovery was higher in patients with initial H-B grades 3-4 than initial H-B grades 5-6 (82.9% vs. 68.2%, p < 0.001). Multivariable logistic regression analysis showed that age 19-65 years and good electromyography (EMG) results were prognostic of good outcomes in patients with initial H-B grades 3-4. In addition, good EMG results, controlled hypertension, and combination antiviral therapy were significantly prognostic of favorable outcomes in patients with initial H-B grades 5-6. Subgroup analysis interactions showed that combination antiviral therapy (OR: 3.06, 95% CI 1.62-5.78, p < 0.001) in initial H-B grades 5-6 were associated with more favorable outcomes at 6 months than with initial H-B grades 3-4. Our results showed that the proportion of patients who achieved favorable outcomes at 6 months and multiple clinical factors affecting favorable outcomes differed significantly among patients differing in initial severity of Bell's palsy.
Collapse
Affiliation(s)
- Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul 02447, Korea;
| | - Dong Choon Park
- St. Vincent’s Hospital, The Catholic University of Korea, Suwon 16247, Korea;
| | - Seung Geun Yeo
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul 02447, Korea
| |
Collapse
|
13
|
Allegra S, Church R, Sudireddy V. A Rare Case of Cranial Nerve VII Neuropraxia Associated with Alveolar Nerve Blocks. Clin Pract Cases Emerg Med 2021; 5:273-274. [PMID: 34437027 PMCID: PMC8143834 DOI: 10.5811/cpcem.2021.4.51264] [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] [Received: 12/20/2020] [Accepted: 04/01/2021] [Indexed: 11/11/2022] Open
Abstract
CASE PRESENTATION A 26-year-old male presented to our emergency department for six days of right-sided facial myasthenia and parasthesias following a dental procedure using anesthetic nerve blocks. DISCUSSION Iatrogenic cranial nerve VII neuropraxia, a peripheral nerve injury, is an uncommon complication of alveolar nerve blocks with few documented cases specifically due to dental anesthesia. Treatment usually involves use of oral corticosteroid and/or antiviral medications along with close follow-up in clinic with a neurologist and/or otolaryngologist.
Collapse
Affiliation(s)
- Stephen Allegra
- University of Massachusetts Memorial Medical Center, Department of Emergency Medicine, Worcester, Massachusetts
| | - Richard Church
- University of Massachusetts Memorial Medical Center, Department of Emergency Medicine, Worcester, Massachusetts
| | - Veera Sudireddy
- University of Massachusetts Memorial Medical Center, Department of Emergency Medicine, Worcester, Massachusetts
| |
Collapse
|
14
|
Fujiwara K, Fukuda A, Morita S, Yanagi H, Hoshino K, Nakamaru Y, Furuta Y, Homma A. Psychological evaluation for patients with non-cured facial nerve palsy. Auris Nasus Larynx 2021; 49:53-57. [PMID: 33962818 DOI: 10.1016/j.anl.2021.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/02/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the psychological condition of patients with non-cured facial nerve palsy and to investigate whether their psychological condition is correlated with the degree of facial nerve palsy, synkinesis or quality of life. METHODS Thirty patients with non-cured facial nerve palsy were enrolled in this study. Psychological conditions were evaluated by questionnaires including State-Trait Anxiety Inventory and Self-rating Depression Scale. RESULTS Of the thirty patients with non-cured facial nerve palsy, 17 (56.7%) and 15 patients (50.0%) felt anxiety and depression, respectively. Although there were no significant correlations between their psychological condition and the degree of facial nerve palsy or that of sequelae, significant correlations were observed between psychological condition and the degree of QOL, especially in terms of social function. CONCLUSIONS AND SIGNIFICANCE Disabilities associated with facial nerve palsy may be overlooked when evaluation is performed by physician-graded instruments alone. To resolve this problem, patients with non-cured facial nerve palsy should be evaluated by not only physician-graded tools but also patient-based assessment tools.
Collapse
Affiliation(s)
- Keishi Fujiwara
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-Ku, N15W7, Sapporo 0608638, Hokkaido, Japan.
| | - Atsushi Fukuda
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-Ku, N15W7, Sapporo 0608638, Hokkaido, Japan
| | - Shinya Morita
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-Ku, N15W7, Sapporo 0608638, Hokkaido, Japan
| | - Hiroko Yanagi
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-Ku, N15W7, Sapporo 0608638, Hokkaido, Japan
| | - Kimiko Hoshino
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-Ku, N15W7, Sapporo 0608638, Hokkaido, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-Ku, N15W7, Sapporo 0608638, Hokkaido, Japan
| | - Yasushi Furuta
- Department of Otolaryngology, Head and Neck Surgery, Teine-Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-Ku, Sapporo 0068555, Hokkaido, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-Ku, N15W7, Sapporo 0608638, Hokkaido, Japan
| |
Collapse
|
15
|
Inagaki A, Katsumi S, Sekiya S, Murakami S. Intratympanic steroid therapy for Bell's palsy with poor prognostic results. Sci Rep 2021; 11:8058. [PMID: 33850231 PMCID: PMC8044212 DOI: 10.1038/s41598-021-87551-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 03/30/2021] [Indexed: 11/08/2022] Open
Abstract
In Bell's palsy, electrodiagnosis by electroneurography (ENoG) is widely used to predict a patient's prognosis. The therapeutic options for patients with poor prognostic results remain controversial. Here, we investigated whether early intervention with intratympanic steroid therapy (ITST) is an effective treatment for Bell's palsy patients with poor electrodiagnostic test results (≤ 10% electroneurography value). Patients in the concurrent ITST group (n = 8) received the standard systemic dose of prednisolone (410 mg total) and intratympanic dexamethasone (16.5 mg total) and those in the control group (n = 21) received systemic prednisolone at the standard dose or higher (average dose, 605 ± 27 mg). A year after onset, the recovery rate was higher in the ITST group than in the control group (88% vs 43%, P = 0.044). The average House-Brackmann grade was better in the concurrent ITST group (1.13 ± 0.13 vs 1.71 ± 0.16, P = 0.035). Concurrent ITST improves the facial nerve outcome in patients with poor electroneurography test results, regardless of whether equivalent or lower glucocorticoid doses were administered. This may be ascribed to a neuroprotective effect of ITST due to a higher dose of steroid reaching the lesion due to dexamethasone transfer in the facial nerve.
Collapse
Affiliation(s)
- Akira Inagaki
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan.
| | - Sachiyo Katsumi
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shinji Sekiya
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Shingo Murakami
- Departments of Otolaryngology, Head and Neck Surgery, Nagoya City University, Graduate School of Medical Sciences and Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| |
Collapse
|
16
|
Yoo MC, Soh Y, Chon J, Lee JH, Jung J, Kim SS, You MW, Byun JY, Kim SH, Yeo SG. Evaluation of Factors Associated With Favorable Outcomes in Adults With Bell Palsy. JAMA Otolaryngol Head Neck Surg 2021; 146:256-263. [PMID: 31971554 DOI: 10.1001/jamaoto.2019.4312] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Identification of the factors associated with improved facial nerve function after treatment of Bell palsy is important to provide patients with early and effective treatment. Objective To identify factors that are associated with improved treatment outcomes in patients with Bell palsy. Design, Setting, and Participants This retrospective cohort study included 1364 patients with Bell palsy treated at the outpatient clinic of the Department of Otolaryngology at the Kyung Hee University Hospital, Seoul, Republic of Korea, between January 1, 2005, and December 31, 2017. The medical records of patients admitted to this hospital for management of acute facial palsy were reviewed by 3 otolaryngologists with more than 20 years' experience in treating facial palsy. Main Outcomes and Measures Facial function at the initial and final visits were measured using the House-Brackmann (H-B) grading system, which is one of several analysis tools developed to quantify facial function and provide reproducible information. It is a widely accepted system for grading facial function in 6 steps, from normal (H-B grade I) to total paralysis (H-B grade VI). Results In total, 1364 patients with primary Bell palsy (718 [52.6%] women) and a mean (SD) age of 47.7 (16.7) years were enrolled. The overall rate of favorable outcome, which was defined as an H-B grade of I or II at the 6-month follow-up visit, was 80.6% (1099 of 1364 patients). Of 1099 patients who had a favorable outcome at 6 months, 343 (31.2%) were younger than 40 years. Of 1364 patients, 1053 (77.2%) had moderate facial dysfunction (H-B grade III or IV). No pathological spontaneous fibrillation activity (ie, good electromyography [EMG] results) was detected on EMG in 937 of 1364 patients (68.7%), 492 (36.1%) had controlled hypertension, and 673 (49.3%) were treated with oral corticosteroids alone. Multivariable analysis revealed that the following factors were associated with favorable outcome: age younger than 40 years (odds ratio [OR], 1.56; 95% CI, 1.09-2.22), an initial H-B grade of III or IV (OR, 2.62; 95% CI, 1.93-3.57), good EMG results after 2 weeks of treatment (OR, 3.38; 95% CI, 2.48-4.61), absence of diabetes (OR, 1.43; 95% CI, 1.04-2.36), and control of hypertension (OR, 1.64; 95% CI, 1.16-2.33). Conclusions and Relevance Multiple logistic regression analysis in this study suggests that multiple clinical factors are associated with favorable outcomes in patients with Bell palsy.
Collapse
Affiliation(s)
- Myung Chul Yoo
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yunsoo Soh
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jinmann Chon
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jong Ha Lee
- Department of Physical Medicine & Rehabilitation, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Junyang Jung
- School of Medicine, Department of Anatomy and Neurobiology, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Su Kim
- Medical Research Center for Bioreaction to Reactive Oxygen Species and Biomedical Science Institute, School of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Myung-Won You
- School of Medicine, Department of Radiology, Kyung Hee University, Seoul, Republic of Korea
| | - Jae Yong Byun
- School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Hoon Kim
- School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
17
|
Facial Weakness, Dysarthria, and Dysphagia. Neurology 2021. [DOI: 10.1007/978-3-030-55598-6_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
18
|
Abstract
Facial paralysis is a devastating condition, encompassing a spectrum of disorders, with resultant psychosocial, functional, and aesthetic sequelae. With this in mind, an individualized treatment approach based on the cause, pattern, and duration of palsy is necessary. Treatment options include pharmacologic agents, corneal protective interventions, physical therapy, and surgical procedures. The use of steroids and antivirals in the setting of idiopathic facial paralysis or virus-associated facial paralysis is well supported. Despite the diversity of surgical interventions described, there is a lack of consensus regarding optimal treatment. This article provides an overview of the current management of facial paralysis. Medical, surgical, and physical treatment options are discussed with a review of the relevant literature.
Collapse
Affiliation(s)
- Tom Shokri
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Babak Azizzadeh
- Department of Facial Plastic & Reconstructive Surgery, Center for Advanced Facial Plastic Surgery, Beverly Hills, California
- Division of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| |
Collapse
|
19
|
Concurrent Treatment With Intratympanic Dexamethasone for Moderate-Severe Through Severe Bell's Palsy. Otol Neurotol 2020; 40:e1018-e1023. [PMID: 31469789 DOI: 10.1097/mao.0000000000002377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether early intervention with intratympanic steroid injection, known as concurrent intratympanic steroid therapy, is effective as a supplement to systemic steroid therapy for treating moderate-severe to severe Bell's palsy. DESIGN An open-label historical control trial. SETTING Tertiary referral center. PARTICIPANTS A total of 35 Bell's palsy patients presenting with House-Brackmann grade IV or higher were treated with intratympanic steroid therapy concurrent with standard systemic treatment and compared with 108 patients treated with standard systemic therapy alone started within 7 days of onset. INTERVENTIONS In the concurrent intratympanic steroid therapy group, patients received both 410 mg of prednisolone (standard dose) and 1.65 mg of intratympanic dexamethasone for 10 consecutive days. Patients in the control group received the standard dose, or more, of systemic prednisolone. Both groups were additionally treated with valacyclovir. MAIN OUTCOMES AND MEASURES The primary outcome measure was restoration of a House-Brackmann score of grade I. RESULTS The rate of recovery to House-Brackmann Grade I was higher for the concurrent intratympanic steroid therapy group than for the control group (94% vs 73%, p = 0.008). The adjusted odds ratio was 5.47 (95% confidence interval: 1.18-25.21, p = 0.029). CONCLUSIONS The recovery rate was higher for concurrent intratympanic steroid therapy treatment than for standard-of-care control treatment, regardless of whether steroid with lower or equivalent glucocorticoid action was administered. This result suggests that concurrent treatment with intratympanic steroid therapy is a potentially beneficial supplement to systemic steroid administration.
Collapse
|
20
|
Ashour A, Obeidat K, Azrieh B, Alsaud A, Yassin M. An Association of Varicella Zoster Virus, Facial Palsy, and Meningitis in a Young Immunocompetent Male. Case Rep Neurol 2020; 12:136-139. [PMID: 32399017 PMCID: PMC7204867 DOI: 10.1159/000506192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022] Open
Abstract
Varicella zoster is a secondary infection caused by the virus of chickenpox, after becoming latent in neurons of dorsal root ganglia or trigeminal ganglia. Varicella zoster virus (VZV) can be reactivated years later to produce shingles (zoster), generally in immunocompromised adults to produce neurological deficits and rash. Meningeal involvement of VZV is also reported and can be diagnosed. Herein, we report a 39-year-old immunocompetent male adult with a rare manifestation caused by VZV. The report is an association between facial nerve palsy and a polymerase chain reaction-confirmed VZV meningitis, even without the dermal typical rash. The patient eventually recovered after receiving acyclovir intravenously.
Collapse
Affiliation(s)
- Amr Ashour
- *Amr Ashour, MD, Resident, Internal Medicine, Hamad Medical Corporation, Al-Aziziya, Asian Village 10, PO Box 3050, Doha (Qatar),
| | | | | | | | | |
Collapse
|
21
|
Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Prognostic Hematologic Markers of Bell's Palsy: A Meta-analysis. Otol Neurotol 2020; 40:681-687. [PMID: 31083100 DOI: 10.1097/mao.0000000000002166] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Bell's palsy (BP) is the most common cause of unilateral peripheral facial paralysis, and inflammation has been proposed as the main pathological cause. The study aim was to investigate the relationship between hematologic inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), and BP. DATA SOURCES The following key words were used to search PubMed and Scopus for English language articles: Bell's palsy, facial palsy, facial paresis or facial paralysis, neutrophil, lymphocyte, and platelet. STUDY SELECTION Articles related to BP with NLR or PLR data. DATA EXTRACTION The data included patient profiles, House-Brackmann score, treatment modality, NLR, and PLR. DATA SYNTHESIS Seven articles were selected. A random effect model was used to analyze the aggregated data. Six of these articles that included the NLR and two that included the PLR of BP and control patients were analyzed for the difference between BP and control patients. Three articles that included the NLR of the recovery and nonrecovery groups were analyzed for the relationship between NLR and recovery. CONCLUSIONS The NLR was significantly higher for the BP patients than for the controls. Furthermore, the NLR was significantly lower for the recovery group than for the nonrecovery group. A high NLR was associated with poor prognosis and related to the severity of facial nerve inflammation. There was no significant difference between the PLRs of the BP patients and controls. The NLR, but not the PLR, was found to be a useful prognostic indicator of BP.
Collapse
|
22
|
Inagaki A, Minakata T, Katsumi S, Murakami S. Concurrent treatment with intratympanic dexamethasone improves facial nerve recovery in Ramsay Hunt syndrome. J Neurol Sci 2020; 410:116678. [DOI: 10.1016/j.jns.2020.116678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 11/25/2022]
|
23
|
Nerve Integrity Monitor Responses to Direct Facial Nerve Stimulation During Facial Nerve Decompression Surgery Can Predict Postoperative Outcomes. Otol Neurotol 2020; 41:704-708. [PMID: 32080029 DOI: 10.1097/mao.0000000000002594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test whether the threshold of nerve integrity monitor (NIM) responses during facial nerve decompression surgery can predict the postoperative outcome. STUDY DESIGN Retrospective study. SETTING University hospital. PATIENTS Twenty peripheral facial palsy patients who underwent transmastoid decompression surgery. INTERVENTION During decompression surgery, thresholds of NIM responses were measured via direct facial nerve stimulation at three sites: the geniculate ganglion (GG), the second genu (2 G), and the stylomastoid foramen. MAIN OUTCOME MEASURES Facial nerve function was evaluated before and 6 months after surgery using the Yanagihara grading score (maximum score = 40 points). Complete recovery was defined as an improvement of the grading score to ≥ 36 points without synkinesis. Variables including age, sex, disease (Bell's palsy or Ramsay Hunt syndrome), time after onset, Yanagihara grading score, and electroneurography before surgery, and the thresholds of NIM responses during surgery were compared in the complete and incomplete recovery groups. NIM responders were defined as those exhibiting a NIM response of < 1.5 mA at any site. Postoperative Yanagihara grading scores in NIM responders and NIM nonresponders were compared. RESULTS No variables differed significantly in the complete and incomplete recovery groups before surgery. NIM response thresholds in the complete recovery group at the GG and the 2nd G were significantly lower than the corresponding thresholds in the incomplete recovery group. The postoperative Yanagihara grading scores of NIM responders were significantly better than those of NIM nonresponders. CONCLUSION NIM responses to intraoperative direct facial nerve stimulation were useful for predicting outcomes after decompression surgery.
Collapse
|
24
|
Georg Heckmann J, Paul Urban P, Pitz S, Guntinas-Lichius O, Gágyor I. The Diagnosis and Treatment of Idiopathic Facial Paresis (Bell's Palsy). DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:692-702. [PMID: 31709978 PMCID: PMC6865187 DOI: 10.3238/arztebl.2019.0692] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/01/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Peripheral facial nerve palsy is the most com- mon functional disturbance of a cranial nerve. 60-75% of cases are idiopathic. METHODS This review is based on a selective literature search proceeding from the current, updated German-language guideline on the diagnosis and treatment of idiopathic facial nerve palsy. RESULTS The recommended drug treatment consists of prednisolone 25 mg bid for 10 days, or 60 mg qd for 5 days followed by a taper to off in decrements of 10 mg per day. This promotes full recovery (number needed to treat [NNT] = 10; 95% confidence interval [6; 20]) and lessens the risk of late sequelae such as synkinesia, autonomic disturbances, and contractures. Virostatic drugs are optional in severe cases (intense pain or suspicion of herpes zoster sine herpete) and mandatory in cases of varicella-zoster virus (VZV) infection. Corneal protection with dexpanthenol ophthalmic ointment, artificial tears, and a nocturnal moisture- retaining eye shield has been found useful in practice. In cases of incomplete recovery with residual facial weakness, both static and microsurgical dynamic methods can be used to restore facial nerve function. CONCLUSION Because 25-40% of cases of facial nerve palsy are not idiopathic, differential diagnosis is very important; key diagnostic methods include a clinical neurological examin- ation, otoscopy, and a lumbar puncture for cerebrospinal fluid examination. High-level evidence supports corticosteroid treatment for the idiopathic form of the disorder.
Collapse
Affiliation(s)
| | | | | | | | - Ildik? Gágyor
- Department of General Practice, Julius-Maximilians-Universität Würzburg
| |
Collapse
|
25
|
Gagyor I, Madhok VB, Daly F, Sullivan F. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2019; 9:CD001869. [PMID: 31486071 PMCID: PMC6726970 DOI: 10.1002/14651858.cd001869.pub9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. This review was first published in 2001 and most recently updated in 2015. Since a significant benefit of corticosteroids for the early management of Bell's palsy has been demonstrated, the main focus of this update, as in the previous version, was to determine the effect of adding antivirals to corticosteroid treatment. We undertook this update to integrate additional evidence and to better assess the robustness of findings, taking risk of bias fully into account. OBJECTIVES To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. SEARCH METHODS We searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS in July 2019. We reviewed the bibliographies of the identified trials and contacted trial authors to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. SELECTION CRITERIA We considered randomised controlled trials (RCTs) or quasi-RCTs of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that followed-up participants for less than three months. DATA COLLECTION AND ANALYSIS We independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. We performed sensitivity analyses excluding trials at high or unclear risk of bias in at least five domains, and reported these data as the primary analyses. MAIN RESULTS Fourteen trials, including 2488 participants, met the inclusion criteria. Most were small, and most were at high or unclear risk of bias in multiple domains. We included four new studies at this update.Incomplete recoveryA combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in people with Bell's palsy compared to corticosteroids alone (risk ratio (RR) 0.81, 95% confidence interval (CI) 0.38 to 1.74; 3 trials, N = 766; random-effects; low-certainty evidence). We excluded 10 trials that were at high or unclear risk of bias in several domains from this analysis and limited all analyses to studies at lower risk of bias. Recovery rates were better in participants receiving corticosteroids alone than antivirals alone (RR 2.69, 95% CI 0.73 to 10.01; 2 trials, N = 667; random-effects), but the result was imprecise and allowed for the possibility of no effect. The rate of incomplete recovery was lower with antivirals plus corticosteroids than with placebo or no treatment (RR 0.56, 95% CI 0.42 to 0.76; 2 trials, N = 658; random-effects). Antivirals alone had no clear effect on incomplete recovery rates compared with placebo, but the result was imprecise (RR 1.10, 95% CI 0.87 to 1.40; 2 trials, N = 658; fixed-effect). For people with severe Bell's palsy (House-Brackmann score of 5 and 6, or equivalent on other scales), we found that the combination of antivirals and corticosteroids had no clear effect on incomplete recovery at month six compared to corticosteroids alone, although the result was again imprecise (RR 0.82, 95% CI 0.57 to 1.17; 2 trials, N = 98; random-effects).Motor synkinesis or crocodile tearsAntivirals plus corticosteroids reduced the proportion of participants who experienced these long-term sequelae from Bell's palsy compared to placebo plus corticosteroids (RR 0.56, 95% CI 0.36 to 0.87; 2 trials, N = 469; fixed-effect; moderate-certainty evidence). Antivirals plus corticosteroids reduced long-term sequelae compared to placebo but there was no clear difference in this outcome with antivirals alone compared to placebo.Adverse events Adverse event data were available in four studies providing data on 1592 participants. None of the four comparisons showed clear differences in adverse events between treatment and comparison arms (very low-certainty evidence); for the comparison of antivirals plus corticosteroids and corticosteroids alone in studies at lower risk of bias, the RR was 1.17 (95% CI 0.81 to 1.69; 2 trials, N = 656; fixed-effect; very low-certainty evidence). AUTHORS' CONCLUSIONS The combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in comparison to corticosteroids alone in Bell's palsy of various degrees of severity, or in people with severe Bell's palsy, but the results were very imprecise. Corticosteroids alone were probably more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no clear benefit from antivirals alone over placebo.The combination of antivirals and corticosteroids probably reduced the late sequelae of Bell's palsy compared with corticosteroids alone. Studies also showed fewer episodes of long-term sequelae in corticosteroid-treated participants than antiviral-treated participants.We found no clear difference in adverse events from the use of antivirals compared with either placebo or corticosteroids, but the evidence is too uncertain for us to draw conclusions.An adequately powered RCT in people with Bell's palsy that compares different antiviral agents may be indicated.
Collapse
Affiliation(s)
- Ildiko Gagyor
- Universitätsklinikum WürzburgDepartment of General PracticeJosef‐Schneider‐Straße 2WürzburgBavariaGermany97080
| | | | - Fergus Daly
- Frontier Science (Scotland) LtdGrampian View Kincraig,KingussieInverness‐shireUKPH21 1NA
| | - Frank Sullivan
- University of St AndrewsDivision of Population & Behavioural ScienceNorth HaughUniversity of St AndrewsSt AndrewsUKKY16 9TF
| | | |
Collapse
|
26
|
|
27
|
Delayed-onset facial nerve paresis following cochlear implantation: case report and literature review. The Journal of Laryngology & Otology 2018; 132:1150-1152. [PMID: 30565529 DOI: 10.1017/s0022215118002074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Facial nerve paresis is rare following cochlear implantation. Mechanisms underlying delayed-onset facial paresis are poorly understood. This paper describes the case of a patient who developed facial nerve paresis three years after implantation. A literature review was performed with the aim of identifying any similar cases. METHODS The patient case is reported, and the literature reviewed using PubMed, Embase and Ovid databases. RESULTS The literature review revealed that the vast majority of delayed-onset facial nerve paresis cases occur within the first month of implantation. Only two other cases occurring years after device implantation were identified. Although potential causative factors have been suggested, as in our case this phenomenon may be idiopathic. CONCLUSION Prognosis for recovery of late-onset facial nerve paresis seems promising, despite the unfortunate requirement for device explantation in all previous cases including our own.
Collapse
|
28
|
Abstract
Acute facial paralysis (FP) describes acute onset of partial or complete weakness of the facial muscles innervated by the facial nerve. Acute FP occurs within a few hours to days. The differential diagnosis is broad; however, the most common cause is viral-associated Bell Palsy. A comprehensive history and physical examination are essential in arriving at a diagnosis. Medical treatment for acute FP depends on the specific diagnosis; however, corticosteroids and antiviral medications are the cornerstone of therapy. Lack of recovery after 4 months should prompt further diagnostic workup.
Collapse
Affiliation(s)
- Teresa M O
- Facial Nerve Center, Vascular Birthmark Institute of New York, Department of Otolaryngology-Head and Neck Surgery, Manhattan Eye, Ear, and Throat Hospital, Lenox Hill Hospital, 210 East 64th Street, 7th Floor, New York, New York, 10065, USA.
| |
Collapse
|
29
|
Abstract
Bell palsy and traumatic facial nerve injury are two common causes of acute facial palsy. Most patients with Bell palsy recover favorably with medical therapy alone. However, those with complete paralysis (House-Brackmann 6/6), greater than 90% degeneration on electroneurography, and absent electromyography activity may benefit from surgical decompression via a middle cranial fossa (MCF) approach. Patients with acute facial palsy from traumatic temporal bone fracture who meet these same criteria may be candidates for decompression via an MCF or translabyrinthine approach based on hearing status.
Collapse
Affiliation(s)
- Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St 6th Floor, Baltimore MD, 21287, USA.
| | - Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St 6th Floor, Baltimore MD, 21287, USA
| | - Bruce J Gantz
- University of Iowa Hospitals and Clinics, 375 Newton Road, Iowa City, IA 52242, USA
| |
Collapse
|
30
|
Abstract
Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications.
Collapse
|
31
|
Chang DS, Lee J, Shin SA, Lee HY. Characteristics of patients with acute peripheral facial palsy showing
Varicella zoster virus
DNA in saliva. J Med Virol 2018; 90:959-964. [DOI: 10.1002/jmv.25030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Dong Sik Chang
- Department of OtorhinolaryngologyEulji University HospitalEulji UniversityDaejeonRepublic of Korea
| | - Jun Lee
- Department of OtorhinolaryngologyEulji University HospitalEulji UniversityDaejeonRepublic of Korea
| | - Sun Ae Shin
- Department of Medical ScienceChungnam National UniversityDaejeonKorea
| | - Ho Yun Lee
- Department of OtorhinolaryngologyEulji University HospitalEulji UniversityDaejeonRepublic of Korea
| |
Collapse
|
32
|
Doshi D, Saab M. Bell'S Palsy in Children: Is There Any Role of Steroid or Acyclovir? HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790701400408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We describe a case of a seven-year-old child with Bell's palsy who made a full recovery without the use of steroid or acyclovir. This is followed by a review of the literature to see whether or not there is any role of steroid or acyclovir in childhood Bell's palsy.
Collapse
Affiliation(s)
| | - M Saab
- Fairfield General Hospital, Rochdale Old Road, Bury BL9 7TD, United Kingdom
| |
Collapse
|
33
|
Abstract
The functional and psychosocial impact of facial paralysis on the patient is significant. In response, a broad spectrum of treatment options exist and are provided by a multitude of health care practitioners. The cause and duration of the facial weakness can vary widely and the optimal care pathway varies. To optimize patient outcome, those involved in the care of patients with facial palsy should collaborate within comprehensive multidisciplinary teams (MDTs). At an international level, those involved in the care of patients with facial paralysis should aim to create standardized guidelines on which outcome domains matter most to patients to aid the identification of high quality care. This review summarizes the causes and treatment options for facial paralysis and discusses the subsequent importance of multidisciplinary care in the management of patients with this condition. Further discussion is given to the extended role of the MDT in determining what constitutes quality in facial palsy care to aid the creation of accepted care pathways and delineate best practice.
Collapse
Affiliation(s)
- Daniel P Butler
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| | - Adriaan O Grobbelaar
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, UK
| |
Collapse
|
34
|
Affiliation(s)
| | - Frank Sullivan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| |
Collapse
|
35
|
Babl FE, Mackay MT, Borland ML, Herd DW, Kochar A, Hort J, Rao A, Cheek JA, Furyk J, Barrow L, George S, Zhang M, Gardiner K, Lee KJ, Davidson A, Berkowitz R, Sullivan F, Porrello E, Dalziel KM, Anderson V, Oakley E, Hopper S, Williams F, Wilson C, Williams A, Dalziel SR. Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial. BMC Pediatr 2017; 17:53. [PMID: 28193257 PMCID: PMC5307816 DOI: 10.1186/s12887-016-0702-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial. METHODS/DESIGN We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with primary outcome presented as differences in proportions and an odds ratio adjusted for site and age. DISCUSSION This large multicenter randomised trial will allow the definitive assessment of the efficacy of prednisolone compared with placebo in the treatment of Bell's palsy in children. TRIAL REGISTRATION The study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561 (1 June 2015).
Collapse
Affiliation(s)
- Franz E. Babl
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Mark T. Mackay
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Neurology, Royal Children’s Hospital, Parkville, VIC Australia
| | - Meredith L. Borland
- Princess Margaret Hospital for Children, Perth, Australia
- Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia Australia
| | - David W. Herd
- Lady Cilento Children’s Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
| | - Amit Kochar
- Women’s & Children’s Hospital, Adelaide, Australia
| | - Jason Hort
- The Children’s Hospital at Westmead, Sydney, Australia
| | - Arjun Rao
- Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - John A. Cheek
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Monash Medical Centre, Clayton, Victoria, Australia
| | - Jeremy Furyk
- Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Australia
| | - Lisa Barrow
- Sunshine Hospital, St Albans, Victoria Australia
| | - Shane George
- Gold Coast University Hospital, Southport, Queensland Australia
| | - Michael Zhang
- John Hunter Hospital, Newcastle, New South Wales Australia
| | - Kaya Gardiner
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Katherine J. Lee
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Andrew Davidson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Anaesthesia, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Robert Berkowitz
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Otolaryngology, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Frank Sullivan
- Department of Family & Community Medicine, North York General Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Emily Porrello
- Pharmacy Department, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Kim Marie Dalziel
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Centre for Health Policy Melbourne School of Global and Population Health, The University of Melbourne, Carlton, Victoria Australia
| | - Vicki Anderson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Psychological Sciences & Paediatrics, University of Melbourne, The Royal Children’s Hospital, Melbourne, VIC Australia
| | - Ed Oakley
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Sandy Hopper
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Fiona Williams
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Catherine Wilson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Amanda Williams
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Stuart R Dalziel
- Starship Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - for the PREDICT (Paediatric Research In Emergency Departments International Collaborative) research network
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Neurology, Royal Children’s Hospital, Parkville, VIC Australia
- Princess Margaret Hospital for Children, Perth, Australia
- Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
- Women’s & Children’s Hospital, Adelaide, Australia
- The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Children’s Hospital, Randwick, New South Wales, Australia
- Monash Medical Centre, Clayton, Victoria, Australia
- Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Australia
- Sunshine Hospital, St Albans, Victoria Australia
- Gold Coast University Hospital, Southport, Queensland Australia
- John Hunter Hospital, Newcastle, New South Wales Australia
- Department of Anaesthesia, Royal Children’s Hospital, Parkville, Victoria Australia
- Department of Otolaryngology, Royal Children’s Hospital, Parkville, Victoria Australia
- Department of Family & Community Medicine, North York General Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Pharmacy Department, Royal Children’s Hospital, Parkville, Victoria Australia
- Centre for Health Policy Melbourne School of Global and Population Health, The University of Melbourne, Carlton, Victoria Australia
- Psychological Sciences & Paediatrics, University of Melbourne, The Royal Children’s Hospital, Melbourne, VIC Australia
- Starship Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| |
Collapse
|
36
|
Cárdenas Palacio CA, Múnera Galarza FA. Cutaneous Sensibility Changes in Bell's Palsy Patients. Otolaryngol Head Neck Surg 2017; 156:828-833. [PMID: 28168888 DOI: 10.1177/0194599817690107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Bell's palsy is a cranial nerve VII dysfunction that renders the patient unable to control facial muscles from the affected side. Nevertheless, some patients have reported cutaneous changes in the paretic area. Therefore, cutaneous sensibility changes might be possible additional symptoms within the clinical presentation of this disorder. Accordingly, the aim of this research was to investigate the relationship between cutaneous sensibility and facial paralysis severity in these patients. Study Design Prospective longitudinal cohort study. Settings Tertiary care medical center. Subjects and Methods Twelve acute-onset Bell's palsy patients were enrolled from March to September 2009. In addition, 12 sex- and age-matched healthy volunteers were tested. Cutaneous sensibility was evaluated with pressure threshold and 2-point discrimination at 6 areas of the face. Facial paralysis severity was evaluated with the House-Brackmann scale. Results Statistically significant correlations based on the Spearman's test were found between facial paralysis severity and cutaneous sensitivity on forehead, eyelid, cheek, nose, and lip ( P < .05). Additionally, significant differences based on the Student's t test were observed between both sides of the face in 2-point discrimination on eyelid, cheek, and lip ( P < .05) in Bell's palsy patients but not in healthy subjects. Conclusion Such results suggest a possible relationship between the loss of motor control of the face and changes in facial sensory information processing. Such findings are worth further research about the neurophysiologic changes associated with the cutaneous sensibility disturbances of these patients.
Collapse
|
37
|
Benefits of High-dose Steroid + Hespander + Mannitol Administration in the Treatment of Bell's Palsy. Otol Neurotol 2017; 38:272-277. [DOI: 10.1097/mao.0000000000001307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Hussain A, Nduka C, Moth P, Malhotra R. Bell's facial nerve palsy in pregnancy: a clinical review. J OBSTET GYNAECOL 2017; 37:409-415. [PMID: 28141956 DOI: 10.1080/01443615.2016.1256973] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Bell's facial nerve palsy (FNP) during pregnancy and the puerperium can present significant challenges for the patient and clinician. Presentation and prognosis can be worse in this group of patients. This article reviews the background, manifestation and management options of FNP. In particular, it focuses on the controversies that exist regarding corticosteroid use during pregnancy and outlines approaches to diagnosis and treatment. Based on this review, we recommend an early evidence-based approach using guidelines derived from non-pregnant populations. This includes assessment for atypical causes, a multidisciplinary input and early introduction of corticosteroids to limit progression and improve prognosis.
Collapse
Affiliation(s)
- Ahsen Hussain
- a Corneoplastic Unit , Queen Victoria Hospital NHS Foundation Trust , East Grinstead , UK
| | - Charles Nduka
- b Department of Plastic Surgery , Queen Victoria Hospital NHS Foundation Trust , East Grinstead , UK
| | - Philippa Moth
- c Department of Obstetrics and Gynaecology , Maidstone & Tunbridge Wells NHS Trust , Kent , UK
| | - Raman Malhotra
- a Corneoplastic Unit , Queen Victoria Hospital NHS Foundation Trust , East Grinstead , UK
| |
Collapse
|
39
|
Choi SA, Shim HS, Jung JY, Kim HJ, Kim SH, Byun JY, Park MS, Yeo SG. Association between recovery from Bell's palsy and body mass index. Clin Otolaryngol 2017; 42:687-692. [PMID: 27886463 DOI: 10.1111/coa.12801] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although many factors have been found to be involved in recovery from Bell's palsy, no study has investigated the association between recovery from Bell's palsy and obesity. This study therefore evaluated the association between recovery from Bell's palsy and body mass index (BMI). METHODS Subjects were classified into five groups based on BMI (kg/m2 ). Demographic and clinical characteristics were compared among these groups. Assessed factors included sex, age, time from paralysis to visiting a hospital, the presence of comorbidities such as diabetes mellitus and hypertension, degree of initial facial nerve paralysis by House-Brackmann (H-B) grade and neurophysiological testing, and final recovery rate. RESULTS Based on BMI, 37 subjects were classified as underweight, 169 as normal weight, 140 as overweight, 155 as obese and 42 as severely obese. Classification of the degree of initial facial nerve paralysis as moderate or severe, according to H-B grade and electroneurography, showed no difference in severity of initial facial paralysis among the five groups (P > 0.05). However, the final recovery rate was significantly higher in the normal weight than in the underweight or obese group (P < 0.05). CONCLUSIONS Obesity or underweight had no effect on the severity of initial facial paralysis, but the final recovery rate was lower in the obese and underweight groups than in the normal group.
Collapse
Affiliation(s)
- S A Choi
- Department of Otorhinolaryngology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - H S Shim
- Department of Anesthesiology and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - J Y Jung
- Department of Anatomy, School of Medicine, Kyung Hee University, Seoul, Korea
| | - H J Kim
- Department of Otorhinolaryngology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - S H Kim
- Department of Otorhinolaryngology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - J Y Byun
- Department of Otorhinolaryngology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - M S Park
- Department of Otorhinolaryngology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - S G Yeo
- Department of Otorhinolaryngology, School of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
40
|
Khedr EM, Badry R, Ali AM, Abo El-Fetoh N, El-Hammady DH, Ghandour AM, Abdel-Haleem A. Steroid/Antiviral for the treatment of Bell’s palsy: Double blind randomized clinical trial. Restor Neurol Neurosci 2016; 34:897-905. [DOI: 10.3233/rnn-150605] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eman Mohamed Khedr
- Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt
| | - Reda Badry
- Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt
| | - Anwer Mohamed Ali
- Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt
| | - Noha Abo El-Fetoh
- Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt
| | - Dina Hatem El-Hammady
- Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt
| | - Abeer Mohamed Ghandour
- Department of Rheumatology and Rehabilitation, Assiut University Hospital, Assiut, Egypt
| | - Ahmed Abdel-Haleem
- Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt
| |
Collapse
|
41
|
Wolfovitz A, Yehudai N, Luntz M. Prognostic factors for facial nerve palsy in a pediatric population: A retrospective study and review. Laryngoscope 2016; 127:1175-1180. [PMID: 27641905 DOI: 10.1002/lary.26307] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 07/18/2016] [Accepted: 08/04/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To identify and analyze factors influencing the outcome of facial nerve palsy (FNP) in a pediatric population. STUDY DESIGN Retrospective study. METHODS Sixty-seven pediatric patients (72 consecutive cases) diagnosed with and treated for FNP were divided into two severity subgroups. Associations between recovery in these groups and categorical variables were assessed using the Fisher exact test and for age using the t test. RESULTS Mean age on admission was 12.0 ± 4.5 years. Neither FNP outcome (graded by severity) nor improvement rates (expressed as the percentage of patients achieving a higher FNP grade over time) were influenced by gender, affected side, presence of polyneuropathy, etiology, or recurrent or familial FNP. In cases with comparable final outcome, improvement rates of those diagnosed with severe FNP on presentation (38.9% of cases) were significantly higher than mild-to-moderate FNP. Of the 47 patients who attended a follow-up examination 2 months after discharge, 70.2% have already recovered (by at least one House-Brackmann [H-B] grade) by the time they were discharged, whereas 90.9% achieved H-B grade ≤2, and 72.3% fully recovered (H-B grade 1) 2 months postdischarge. Adding antiviral medication did not affect FNP improvement rates or outcomes. CONCLUSIONS Rates of infectious and traumatic etiology in our patients were higher than reported for adults, but the most common etiology-as in those adults-was idiopathic. Routine extended diagnostic workup was not helpful, and antiviral medications were ineffective. The prognosis of FNP in pediatric patients is excellent, with 90% recovery by 2 months after initial presentation. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1175-1180, 2017.
Collapse
Affiliation(s)
- Amit Wolfovitz
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Noam Yehudai
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Luntz
- Department of Otolaryngology-Head and Neck Surgery, Bnai-Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
42
|
Infections in the differential diagnosis of Bell’s palsy: a plea for performing CSF analysis. Infection 2016; 45:147-155. [DOI: 10.1007/s15010-016-0933-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/31/2016] [Indexed: 10/21/2022]
|
43
|
Cranial Nerve Disorders. Neurology 2016. [DOI: 10.1002/9781118486160.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
44
|
|
45
|
Comparison of acyclovir and famciclovir for the treatment of Bell's palsy. Eur Arch Otorhinolaryngol 2016; 273:3083-90. [PMID: 26873601 DOI: 10.1007/s00405-016-3927-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
The relative effectiveness of acyclovir and famciclovir in the treatment of Bell's palsy is unclear. This study therefore compared recovery outcomes in patients with Bell's palsy treated with acyclovir and famciclovir. The study cohort consisted of patients with facial palsy who visited the outpatient clinic between January 2006 and January 2014. Patients were treated with prednisolone plus either acyclovir (n = 457) or famciclovir (n = 245). Patient outcomes were measured using the House-Brackmann scale according to initial severity of disease and underlying disease. The overall recovery rate tended to be higher in the famciclovir than in the acyclovir group. The rate of recovery in patients with initially severe facial palsy (grades V and VI) was significantly higher in the famciclovir than in the acyclovir group (p = 0.01), whereas the rates of recovery in patients with initially moderate palsy (grade III-IV) were similar in the two groups. The overall recovery rates in patients without hypertension or diabetes mellitus were higher in the famciclovir than in the acyclovir group, but the difference was not statistically significant. Treatment with steroid plus famciclovir was more effective than treatment with steroid plus acyclovir in patients with severe facial palsy. Famciclovir may be the antiviral agent of choice in the treatment of patients with severe facial palsy.
Collapse
|
46
|
Antiviral agents convey added benefit over steroids alone in Bell's palsy; decompression should be considered in patients who are not recovering. The Journal of Laryngology & Otology 2016; 129:300-6. [PMID: 25907276 DOI: 10.1017/s0022215115000341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The management of Bell's palsy has been the subject of much debate, with corticosteroids being the preferred medication. However, evidence also supports the use of antiviral drugs for severe cases and even decompression surgery in patients who, despite medical treatment, are not recovering. METHOD A literature review was conducted on the management of Bell's palsy. RESULTS This paper describes the background, statistical evidence, study results and pathophysiological theories that support more aggressive treatment for patients with severe palsy and those who have inadequate recovery. CONCLUSION Combination therapy including antiviral medication significantly improves outcomes in patients with severe Bell's palsy. Decompression should be considered in patients who have not recovered with drug treatment.
Collapse
|
47
|
Tarulli A. Facial Weakness, Dysarthria, and Dysphagia. Neurology 2016. [DOI: 10.1007/978-3-319-29632-6_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
48
|
The Importance of the Neutrophil-Lymphocyte Ratio in Patients with Idiopathic Peripheral Facial Palsy. Int J Otolaryngol 2015; 2015:981950. [PMID: 26713095 PMCID: PMC4680058 DOI: 10.1155/2015/981950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 11/19/2015] [Indexed: 12/11/2022] Open
Abstract
Objective. The purpose of this study was to investigate whether or not there was a correlation between the neutrophil-to-lymphocyte ratio (NLR) value and the severity of idiopathic peripheral facial palsy (IPFP) and to determine whether or not NLR could be used as an early predictive parameter in the prognosis of IPFP patients. Material and Method. This retrospective study was conducted on 146 patients who were diagnosed with IPFP. The control group comprised 140 patients. Patients with IPFP were categorized according to the House-Brackmann grading system (HBS). The NLR value was obtained by dividing the neutrophil value by the lymphocyte value. Results. In the IPFP group, the mean NLR value was 3.63 ± 2.74 and, in the control group, 1.84 ± 0.78. The mean NLR value was significantly higher in IPFP patients than in the control subjects (p < 0.0001). The mean NLR value in group A (Grades I-II ) was 2.61 ± 2.28, in group B (Grades III-IV) 3.22 ± 2.65, and in group C (Grades V-VI) 10.69 ± 6.30. Conclusion. We determined that as the severity of IPFP increased, the NLR value increased. The NLR value can be used as a prognostic factor in the early prediction of IPFP prognosis.
Collapse
|
49
|
Gagyor I, Madhok VB, Daly F, Somasundara D, Sullivan M, Gammie F, Sullivan F. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2015:CD001869. [PMID: 26559436 DOI: 10.1002/14651858.cd001869.pub8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Corticosteroids are widely used in the treatment of idiopathic facial paralysis (Bell's palsy), but the effectiveness of additional treatment with an antiviral agent is uncertain. Significant morbidity can be associated with severe cases of Bell's palsy. This review was first published in 2001 and revised several times, most recently in 2009. This version replaces an update of the review in Issue 7 of the Cochrane Library subsequently withdrawn because of an ongoing investigation into the reliability of data from an included study. OBJECTIVES To assess the effects of antiviral treatments alone or in combination with any other therapy for Bell's palsy. SEARCH METHODS On 7 October 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, DARE, NHS EED, and HTA. We also reviewed the bibliographies of the identified trials and contacted trial authors and known experts in the field and relevant drug companies to identify additional published or unpublished data. We searched clinical trials registries for ongoing studies. SELECTION CRITERIA We considered randomised controlled trials or quasi-randomised controlled trials of antivirals with and without corticosteroids versus control therapies for the treatment of Bell's palsy. We excluded trials that had a high risk of bias in several domains. DATA COLLECTION AND ANALYSIS Pairs of authors independently assessed trials for relevance, eligibility, and risk of bias, using standard Cochrane procedures. MAIN RESULTS Ten trials, including 2280 participants, met the inclusion criteria and are included in the final analysis. Some of the trials were small, and a number were at high or unclear risk of bias. Other trials did not meet current best standards in allocation concealment and blinding. Incomplete recoveryWe found a significant benefit from adding antivirals to corticosteroids in comparison with corticosteroids alone for people with Bell's palsy (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.39 to 0.97, n = 1315). For people with severe Bell's palsy (House-Brackmann scores of 5 and 6 or the equivalent in other scales), we found a reduction in the rate of incomplete recovery at month six when antivirals plus corticosteroids were used, compared to corticosteroids alone (RR 0.64, 95% CI 0.41 to 0.99, n = 478). The outcome for the participants receiving corticosteroids alone was significantly better than for those receiving antivirals alone (RR 2.82, 95% CI 1.09 to 7.32, n = 768). The treatment effect of placebo was significantly lower than that of antivirals plus corticosteroids (RR 0.56, 95% CI 0.41 to 0.76, n = 658). Antivirals alone produced no benefit compared with placebo (RR 1.10, 95% CI 0.87 to 1.40, n = 658). Motor synkinesis or crocodile tearsIn two trials comparing antivirals and corticosteroids with corticosteroids and placebo that assessed this outcome, we found a significant difference in long-term sequelae in favour of antivirals plus corticosteroids (RR 0.56, 95% CI 0.36 to 0.87, n = 469). Two trials comparing antivirals alone with corticosteroids alone investigating this outcome showed fewer sequelae with corticosteroids (RR 1.52, 95% CI 1.08 to 2.12, n = 472). We found no data on long-term sequelae for other comparisons. Adverse events Adverse event data were available in three studies giving comparison data on 1528 participants. None of the four comparisons (antivirals plus corticosteroids versus corticosteroids plus placebo or no treatment; antivirals versus corticosteroids; antivirals plus corticosteroids versus placebo; antivirals versus placebo) showed significant differences in adverse events between treatment and control arms. We could find no correlation with specific treatment within these results. AUTHORS' CONCLUSIONS Low-quality evidence from randomised controlled trials showed a benefit from the combination of antivirals with corticosteroids compared to corticosteroids alone for the treatment of Bell's palsy of various degrees of severity. Low-quality evidence showed a benefit of combination therapy compared with corticosteroids alone in severe Bell's palsy. Corticosteroids alone were more effective than antivirals alone and antivirals plus corticosteroids were more effective than placebo or no treatment. There was no benefit from antivirals alone over placebo.Moderate-quality evidence indicated that the combination of antivirals and corticosteroids reduced sequelae of Bell's palsy compared with corticosteroids alone.We found no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids, based on low-quality evidence.
Collapse
Affiliation(s)
- Ildiko Gagyor
- Department of General Practice/Family Medicine, University of Göttingen, Humboldtalle 38, Göttingen, Lower Saxony, Germany, 37073
| | | | | | | | | | | | | |
Collapse
|
50
|
Gagyor I, Madhok VB, Daly F, Somasundara D, Sullivan M, Gammie F, Sullivan F. WITHDRAWN: Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2015:CD001869. [PMID: 26343420 DOI: 10.1002/14651858.cd001869.pub7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Ildiko Gagyor
- Department of General Practice/Family Medicine, University of Göttingen, Humboldtalle 38, Göttingen, Lower Saxony, Germany, 37073
| | | | | | | | | | | | | |
Collapse
|