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Relationship between serum gonadal hormone levels and synkinesis in postmenopausal women and man with idiopathic facial paralysis. Auris Nasus Larynx 2022; 49:782-789. [DOI: 10.1016/j.anl.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/17/2022] [Accepted: 02/13/2022] [Indexed: 11/22/2022]
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Kwon KJ, Bang JH, Kim SH, Yeo SG, Byun JY. Prognosis prediction changes based on the timing of electroneurography after facial paralysis. Acta Otolaryngol 2022; 142:213-219. [PMID: 35073495 DOI: 10.1080/00016489.2021.1976417] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The process of determining the prognosis and subsequent facial nerve decompression has become an important factor in determining the patient's quality of life. AIM In this study, the prognosis of facial paralysis was verified in detail based on the timing of electroneurography (ENOG) and nerve conduction study (NCS). MATERIALS AND METHODS The ENOG and NCS of 368 facial palsy patients were analyzed. House-Brackmann (HB) scale after 6 months was used as an outcome. For the ENOG, nasalis muscle/levator labii superioris alaeque nasi (NL), and orbicularis oculi (OO) muscle were used and NCS performed using temporal, zygomatic, and buccal branches. RESULTS ENOG at the OO performed 4-6 d after onset was ≤10% (p = .002, 10.0-fold) and showed unfavorable results (when the standard was ≥30%). In addition, the ENOG at the NL performed 13-15 d after onset was ≤10% (p = .001, 10.5-fold) and showed unfavorable results (when the standard was ≥30%). CONCLUSIONS The results indicated that ENOG at the OO performed 4-6 d after onset and ENOG at the NL performed 13-15 d after onset had more prognostic value for the outcomes of acute peripheral facial palsy.
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Affiliation(s)
- Ki Jin Kwon
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Je Ho Bang
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Hoon Kim
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jae Yong Byun
- Department of Otolaryngology–Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Fujiwara T, Iwata S, Hosokawa Y, Mitani S. Intratympanic corticosteroid for Bell's palsy and Ramsay Hunt syndrome: Systematic review and meta-analysis. Auris Nasus Larynx 2021; 49:599-605. [PMID: 34980517 DOI: 10.1016/j.anl.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to reveal the efficacy and safety of intratympanic steroid therapy (ITST) in patients with Bell's palsy and Ramsay Hunt syndrome. METHODS A literature search was conducted in PubMed, Embase, Ichushi-Web, and Cochrane Central Register of Controlled Trials. Published randomized controlled trial and observational studies, which compared the combination of intratympanic corticosteroids with systemic corticosteroid versus systemic corticosteroid for Bell's palsy and Ramsay Hunt syndrome, were included for meta-analysis. The primary outcome was non-recovery at the end of the study follow-up. Data was analyzed using Review Manager software, and pooled odds ratio with 95% CI were calculated. RESULTS Three randomized controlled trial and two cohort studies met the eligible criteria, and 350 individuals included for meta-analysis. The timing of intratympanic corticosteroid was varied from once or twice a week to consecutive 10-days. Patients treated with combination of systemic corticosteroids and intratympanic corticosteroids were likely to achieve recovery of normal facial function (OR = 0.36 [95% CI 0.12-1.14]). The subgroup analysis of the timing revealed that daily ITST reduced non-recovery (OR = 0.14 [95% CI 0.04-0.50). However, non-daily ITST did not reduced non-recovery (OR 0.93 [95% CI 0.37-2.34]). CONCLUSION Intratympanic corticosteroid have a potential to reduce non-recovery in patients with Bell's palsy and Ramsay Hunt syndrome. The methods of intratympanic corticosteroid varied among included studies. Further well-designed randomized controlled trial is needed to confirm the effectiveness and to identify an adequate method of intratympanic corticosteroid in these patients.
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Affiliation(s)
- Takashi Fujiwara
- Department of Public Health Research, Kurashiki Clinical Research Institute. Miwa 1-1-1, Kurashiki City, Okayama Prefecture, 710-8602 Japan; Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan.
| | - Shinji Iwata
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime Prefecture, Japan
| | - Yuki Hosokawa
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime Prefecture, Japan
| | - Sohei Mitani
- Department of Otolaryngology-Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime Prefecture, Japan
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Escalante DA, Malka RE, Wilson AG, Nygren ZS, Radcliffe KA, Ruhl DS, Vincent AG, Hohman MH. Determining the Prognosis of Bell's Palsy Based on Severity at Presentation and Electroneuronography. Otolaryngol Head Neck Surg 2021; 166:151-157. [PMID: 33784203 DOI: 10.1177/01945998211004169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the demographics of Bell's palsy and determine how House-Brackmann (HB) grade at nadir and electroneuronography (ENoG) results correlate with HB grade after recovery and development of synkinesis. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care military medical center. METHODS Patients with acute Bell's palsy and adequate follow-up, defined as 6 months or return to HB grade I function, were included. Demographic information, HB scores at nadir and recovery, and ENoG results were collected. RESULTS A total of 112 patient records were analyzed. Ages ranged from 8 to 87 years with peaks at 21 to 25 and 61 to 65 years. Among patients, 16.3% reached a nadir at HB II, 41.9% at HB III, 5.4% at HB IV, 16.3% at HB V, and 20.1% at HB VI. The overall recovery rate was 73.2% to HB I function, 17.0% to HB II, and 9.8% to HB III. The chance of recovery to HB I decreased as the severity of paralysis increased (rs = -1.0, P < .0001). Mean time to recovery to HB I was 6 weeks. Greater degeneration on ENoG suggested worse recovery (rs = 0.62, P = .01). Patients with HB V and VI were most likely to develop synkinesis. CONCLUSION More severe paralysis increased the chance of recovery to HB II or III function. The granularity of this study provides prognostic insights that may inform the counseling of patients with Bell's palsy with respect to prognosis and recovery timeline.
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Affiliation(s)
- Derek A Escalante
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Ronit E Malka
- Otolaryngology-Head and Neck Surgery, San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Zachary S Nygren
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | | | - Douglas S Ruhl
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
| | | | - Marc H Hohman
- Otolaryngology-Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington, USA
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Lee SY, Seong J, Kim YH. Clinical Implication of Facial Nerve Decompression in Complete Bell's Palsy: A Systematic Review and Meta-Analysis. Clin Exp Otorhinolaryngol 2019; 12:348-359. [PMID: 31487771 PMCID: PMC6787481 DOI: 10.21053/ceo.2019.00535] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/15/2019] [Indexed: 11/22/2022] Open
Abstract
We compared the therapeutic efficacy of facial nerve decompression (FND) and conservative treatment in patients with Bell’s palsy through a systematic review and meta-analysis. Primary database search was performed in PubMed, Medline, and Embase. After screening, 13 studies were assessed for their eligibility. Among them, seven studies employing either the House-Brackmann grading system (HBGS) or May’s classification (modified HBGS) were selected for quantitative and qualitative analysis. Based on May’s classification, the degree of recovery was classified into complete (HBGS I), fair (HBGS II–III), or failed (HBGS IV–VI) recovery. The outcomes were assessed between 6 and 12 months after surgery. The estimated pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects model. Cohorts were comprised of patients who underwent FND (n=202, 53.0%) and conservative treatments (n=179, 47.0%). In pooled analysis, the rate of complete recovery was significantly higher in the FND group than in the control group (OR, 2.06; 95% CI, 1.22 to 3.48; P=0.007) showing neither heterogeneity nor publication bias. Meanwhile, the rates of fair recovery (OR, 0.71; 95% CI, 0.42 to 1.21; P=0.208) and failed recovery (OR, 0.60; 95% CI, 0.22 to 1.67; P=0.327) in the FND group were similar to that in the control group. In subgroup analyses, there was no significant difference in the OR according to the operation timing and surgical approach. FND can be a possible treatment option for patients with complete Bell’s palsy, especially for complete recovery, which provide insights on decision-making and outcome prediction. However, FND should be determined carefully given the risk of small study effects and possible complications.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeon Seong
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Kim SH, Jung J, Jung SY, Dong SH, Byun JY, Park MS, Kim SH, Yeo SG. Comparative prognosis in patients with Ramsay-Hunt syndrome and Bell's palsy. Eur Arch Otorhinolaryngol 2019; 276:1011-1016. [PMID: 30707280 DOI: 10.1007/s00405-019-05300-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/16/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Patients with Ramsay-Hunt syndrome have a poorer prognosis than patients with Bell's palsy. Factors of metabolic syndrome affecting prognosis were therefore compared between patients with Ramsay-Hunt syndrome and those with Bell's palsy. METHODS This retrospective study included 106 with Ramsay-Hunt syndrome and 182 with Bell's palsy. Age, sex, body mass index, blood pressure, blood test results, and ENoG results, stratified by House-Brackmann grade, were compared in patients with Ramsay-Hunt syndrome and Bell's palsy. Both groups of patients were treated with steroids and the antiviral agent famciclovir. RESULTS Age, sex, body mass index, dyslipidemia, triglyceride, diabetes, hypertension, and onset of palsy did not differ in patients with Ramsay-Hunt syndrome and Bell's palsy. Rates of favorable recovery in patients with severe facial palsy and DM were lower in patients with Ramsay-Hunt syndrome than with Bell's palsy and were also lower in low-weight, normal weight, and overweight patients with Ramsay-Hunt syndrome than with Bell's palsy. Rates of favorable recovery in patients with severe facial palsy and normal HDL, as well as in patients with severe facial palsy and < 10% ENoG, were lower in patients with Ramsay-Hunt syndrome than with Bell's palsy. CONCLUSIONS Among patients with severe facial palsy, along with diabetes and < 10% ENoG, unfavorable recovery rates were significantly higher in those with Ramsay-Hunt syndrome than with Bell's palsy.
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Affiliation(s)
- Seok Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Republic of Korea
| | - Junyang Jung
- Department of Anatomy and Neurobiology, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Su Young Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Myongji Hospital, Hanyang University Medical Center, Goyang, Republic of Korea
| | - Sung Hwa Dong
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Republic of Korea
| | - Jae Yong Byun
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Republic of Korea
| | - Moon Suh Park
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Republic of Korea
| | - Sang Hoon Kim
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Republic of Korea
| | - Seung Geun Yeo
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, #1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702, Republic of Korea.
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Hah YM, Kim SH, Jung J, Kim SS, Byun JY, Park MS, Yeo SG. Prognostic value of the blink reflex test in Bell's palsy and Ramsay-Hunt syndrome. Auris Nasus Larynx 2018; 45:966-970. [PMID: 29402606 DOI: 10.1016/j.anl.2018.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/20/2017] [Accepted: 01/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell's palsy (BP) or Ramsay Hunt syndrome (RHS). METHODS The House-Brackmann (HB) grade of patients diagnosed with BP and RHS was determined at first visit and 3 months later. Final HB grade III-VI was defined as an incomplete recovery. Factors evaluated as prognostic of poor recovery included electroneurography (ENoG) degeneration rate (DR)>90%, and absence of BR. Rates of complete and incomplete recovery were calculated and the associations between prognostic factors and recovery were determined. RESULTS Of the 129 included patients, 98 (76%) had BP and 31 (24%) had RHS. Absence of BR and low mean ENoG value were significantly associated with incomplete recovery in both the BP and RHS groups (p<0.05 each). Initial HB grade V-VI was significantly associated with rate of incomplete recovery in patients with RHS (p<0.05 each). Severe residual palsy (final HB grade V-VI) in the absence of BR was significantly more frequent in patients with RHS than with BP (p<0.05). CONCLUSION BR test results were a good prognostic indicator in patients with BP and RHS, as were ENoG value. Absence of BR was more frequently associated with severe residual palsy in RHS than in BP.
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Affiliation(s)
- Young Min Hah
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Junyang Jung
- Department of Anatomy, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Su Kim
- Department of Biochemistry and Molecular Biology, Medical Science and Engineering Research Center for Bioreaction to Reactive Oxygen Species, BK-21, School of Medicine, Kyung Hee University, Seoul 130-701, Republic of Korea
| | - Jae Yong Byun
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Moon Suh Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Seung Geun Yeo
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea.
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Acute Facial Nerve Palsy With Ipsilateral Soft Palate Ulcers. J Oral Maxillofac Surg 2017; 75:1906-1914. [DOI: 10.1016/j.joms.2017.02.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 02/19/2017] [Accepted: 02/21/2017] [Indexed: 11/20/2022]
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Abstract
The aim of this study was to compare clinical characteristics, electroneurography (ENoG) results, and functional outcomes of patients with Bell's palsy (BP) and Ramsay Hunt syndrome (RHS).Around 57 patients with BP and 23 patients with RHS were enrolled in this study from January 2010 and September 2015. Both clinical characteristics and ENoG results were recorded at hospital admission. The evaluations of functional outcomes were conducted with House-Brackmann (H-B) grading system at 6-month follow-up.There were no significant differences in age, gender proportion, initial H-B grades, time before commencement of treatment and the presence of comorbid disease in 2 groups. However, the final H-B grades at 6-month follow-up were significantly better in BP patients than RHS patients. The results of ENoG showed that degeneration index (DI) was significantly higher in the RHS group than the BP group. But no significant difference was found in the value of prolonged latency time (PLT) between the 2 groups. In multivariate analysis, age and ENoG DI were independently associated with functional outcome of recovery in the BP group (OR 0.167, 95% CI 0.038-0.622, P = 0.009 and OR 0.289 95% CI 0.107-0.998, P = 0.050, respectively). However, in the RHS group, only ENoG DI was related to the final H-B grades (OR 0.067, 95% CI 0.005-0.882, P = 0.040). Spearman's rank correlation analysis showed that higher age and ENoG DI were related to poorer prognosis in 2 groups (P < 0.05). PLT was related to functional outcomes only in the BP group (rs = 0.460, P < 0.001). The receiver operating characteristic (ROC) of ENoG DI analysis revealed that the cutoff value was 67.0% for BP prognosis and 64.5% for RHS prognosis. What's more, patients with hypertension or diabetes mellitus had both higher final H-B grade and ENoG DI than those without the same comorbidity.Patients with RHS had poorer prognosis than those with BP. Some factors including age, ENoG DI, and the presence of disease influenced recovery from BP and RHS. The present study demonstrated that BP patients with ENoG DI < 67.0% and RHS patients with ENoG DI < 65.5% had a greater opportunity for recovery within half a year.
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Affiliation(s)
| | - Huijing Li
- Department of Pediatrics, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Ibrahim W, Elzouki AN, Husain A, Osman L. Varicella Zoster Aseptic Meningitis: Report of an Atypical Case and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:594-7. [PMID: 26342350 PMCID: PMC4565033 DOI: 10.12659/ajcr.894045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Patient: Female, 15 Final Diagnosis: Varicella Zoster aseptic meningitis Symptoms: — Medication: — Clinical Procedure: Lumber punctur Specialty: Infectious Diseases
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Affiliation(s)
- Walid Ibrahim
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdel-Naser Elzouki
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Husain
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Lubna Osman
- Department of Psychiatry, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Prognostic factors of synkinesis after Bell's palsy and Ramsay Hunt syndrome. Auris Nasus Larynx 2013; 40:431-4. [DOI: 10.1016/j.anl.2013.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 11/18/2022]
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13
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Byun H, Cho YS, Jang JY, Chung KW, Hwang S, Chung WH, Hong SH. Value of electroneurography as a prognostic indicator for recovery in acute severe inflammatory facial paralysis: a prospective study of Bell's palsy and Ramsay Hunt syndrome. Laryngoscope 2013; 123:2526-32. [PMID: 23918352 DOI: 10.1002/lary.23988] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the prognostic and predictive value of electroneuronography (ENoG) in acute severe inflammatory facial paralysis, including Bell's palsy and Ramsay Hunt syndrome (RHS). STUDY DESIGN Prospective observational study. METHODS Patients with acute severe facial paralysis of House-Brackmann (H-B) grade IV or worse and diagnosed with Bell's palsy or RHS were enrolled from August 2007 to July 2011. After treatment with oral corticosteroid, antiviral agent, and protective eye care, patients were followed up until recovery or 12 months from onset. RESULTS Sixty-six patients with Bell's palsy and 22 with RHS were included. Multiple logistic regression analysis showed significant effect of ENoG value on recovery in both Bell's palsy and RHS. Values of ENoG were significantly worse in RHS than Bell's palsy. Chance of early recovery within 6 weeks after correction of ENoG effect was still significantly worse in RHS. Logistic regression analysis showed 90% chance of recovery within 6 months, expected with ENoG values of 69.2% degeneration (Bell's palsy) and 59.3% (RHS). The receiver operating characteristics (ROC) curves showed ENoG values of 82.5% (Bell's palsy) and 78.0% (RHS) as a critical cutoff value of nonrecovery until 1 year, with the best sensitivity and specificity. CONCLUSIONS A higher chance of recovery was expected with better ENoG in Bell's palsy and RHS. Based on our data, nonrecovery is predicted in patients with ENoG value greater than 82.5% in Bell's palsy, and 78% in RHS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Hayoung Byun
- Department of Otorhinolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; and the
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Volk GF, Klingner C, Finkensieper M, Witte OW, Guntinas-Lichius O. Prognostication of recovery time after acute peripheral facial palsy: a prospective cohort study. BMJ Open 2013; 3:bmjopen-2013-003007. [PMID: 23794548 PMCID: PMC3669721 DOI: 10.1136/bmjopen-2013-003007] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Owing to a lack of prospective studies, our aim was to evaluate diagnostic factors, in particular, motor and non-motor function tests, for prognostication of recovery time in patients with acute facial palsy (AFP). DESIGN Prospective cohort study. SETTING University hospital. PARTICIPANTS 259 patients with AFP. MEASUREMENTS Clinical data, facial grading, electrophysiological motor function tests and other non-motor function tests were assessed for their contribution to recovery time. RESULTS The predominant origin of AFP was idiopathic (59%) and traumatic (21%). At baseline, the House-Brackmann scale (HB) was >III in 46% of patients. Follow-up time was 5.6±9.8 months with a complete recovery rate of 49%. The median recovery time was 3.5 months (95% CI 2.2 to 4.7 months). The following variables were associated with faster recovery: Interval between onset of AFP and treatment <6 days versus ≥6 days (median recovery time in months 2.1 vs 6.5; p<0.0001); HB ≤III vs >III (2.2 vs 4.6; p=0.001); no versus presence of pathological spontaneous activity in first electromyography (EMG; 2.8 vs probability of recovery <50%; p<0.0001); no versus voluntary activity in EMG (probability of recovery <50% vs 3.1; p<0.0001); normal versus pathological ipsilateral electroneurography (1.9 vs 6.5; p=0.008), normal versus pathological stapedius reflexes (1.6 vs 3.3; p=0.003). CONCLUSIONS Start of treatment and grading, but most importantly EMG evaluated for pathological spontaneous activity and the stapedius reflex test are powerful prognosticators for estimating the recovery time from AFP. These results need confirmation in larger datasets.
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Affiliation(s)
- Gerd Fabian Volk
- Departments of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Carsten Klingner
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Mira Finkensieper
- Departments of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany
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El Sawy NA, Shahine EM, Alhadidi AS, Achmawi GA, Alhabashy NM. Cellular immune response in prognosis of Bell's palsy and its relation to clinical and electrophysiological findings. ALEXANDRIA JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.ajme.2012.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Noha A. El Sawy
- Alexandria Faculty of Medicine, Department of Physical Medicine , Rheumatology, and Rehabitation, Alexandria, Egypt
| | - Enas M. Shahine
- Alexandria Faculty of Medicine, Department of Physical Medicine , Rheumatology, and Rehabitation, Alexandria, Egypt
| | - Abir S. Alhadidi
- Alexandria Faculty of Medicine, Department of Clinical Pathology, Alexandria, Egypt
| | - Ghada A. Achmawi
- Alexandria Faculty of Medicine, Department of Neurology, Alexandria, Egypt
| | - Nehal M. Alhabashy
- Alexandria Faculty of Medicine, Department of Physiology, Alexandria, Egypt
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Marsk E, Bylund N, Jonsson L, Hammarstedt L, Engström M, Hadziosmanovic N, Berg T, Hultcrantz M. Prediction of nonrecovery in Bell's palsy using Sunnybrook grading. Laryngoscope 2012; 122:901-6. [PMID: 22374870 DOI: 10.1002/lary.23210] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 12/22/2011] [Accepted: 12/29/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop a clinical prognostic model to identify Bell's palsy patients with risk for nonrecovery at 12 months. STUDY DESIGN Data from a prospective, randomized, double-blind, placebo-controlled, multicenter study. METHODS There were 829 patients with Bell's palsy randomized in a factorial fashion to treatment with prednisolone or no prednisolone. Facial function was assessed with the Sunnybrook grading scale. Univariate and multivariate logistic regression analyses at different time points were used to identify factors predicting nonrecovery, defined as Sunnybrook <70 at 12 months. Variables studied were age, gender, time to inclusion, prednisolone treatment, side of palsy, pain at inclusion, and Sunnybrook scores. Factors of predictable significance were used to construct prognostic models at baseline, days 11 to 17, and at 1 month. Receiver operating characteristics curves were created to test the predictive capacity of the models. RESULTS At baseline, treatment with prednisolone or no prednisolone (P = .0005), age (P = .04) and the Sunnybrook score (P = .0002) were significant factors for predicting nonrecovery. The receiver operating characteristics area under the curve at baseline for these three variables was 0.74 (sensitivity 0.83, specificity 0.57). At days 11 to 17 and at 1 month, the Sunnybrook score was the only significant predictive variable. The respective areas under the curves for the Sunnybrook score at these time points were 0.83 (sensitivity 0.81, specificity 0.75) and 0.94 (sensitivity 0.91, specificity 0.85). CONCLUSIONS Sunnybrook grading at 1 month most accurately predicts nonrecovery at 12 months in Bell's palsy.
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Affiliation(s)
- Elin Marsk
- Department of Otorhinolaryngology and Head and Neck Surgery, Karolinska University Hospital, Stockholm, Sweden.
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Kim MW, Kim EH. Re: Prognostic value of electroneurography in Bell's palsy and Ramsay-Hunt's syndrome. Clin Otolaryngol 2011; 36:88-9; author reply 89. [PMID: 21414163 DOI: 10.1111/j.1749-4486.2010.02235.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To assess if early deterioration is a negative prognostic factor in Bell's palsy and if prednisolone treatment reduces early progression and enhances recovery. STUDY DESIGN Data extracted from the randomized, double-blind, placebo-controlled multicenter, Scandinavian Bell's palsy study. SETTING Sixteen tertiary referral centers in Sweden and one in Finland. PATIENTS A total of 829 patients aged 18 to 75 years with Bell's palsy. INTERVENTION The study design was factorial; 416 patients were given prednisolone, whereas 413 did not receive the drug. Data were analyzed with a modified intention-to-treat principle and the last-observation-carried-forward method. MAIN OUTCOME MEASURES Facial function was assessed within 72 hours before treatment start, at Days 11 to 17, and at 12 months. Sunnybrook was used as the main facial grading system with complete recovery defined as Sunnybrook 100. RESULTS In 236 (28%) of 829 patients, the palsy deteriorated from baseline to the first follow-up at Days 11 to 17. Complete recovery at 12 months was 45% among subjects with early deterioration compared with 73% in patients with no initial deterioration (p < 0.0001). In the early deterioration group, complete recovery at 12 months was 62% in patients treated with prednisolone and 31% in those not treated (p < 0.0001). CONCLUSION Early deterioration in Bell's palsy is a negative prognostic factor for complete recovery at 12 months. Prednisolone given within 72 hours may reduce early progression and improve the outcome of palsy.
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Abstract
PURPOSE Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. MATERIALS AND METHODS We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. RESULTS The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. CONCLUSION These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different.
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Affiliation(s)
- Chang Il Cha
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Chang Kee Hong
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Moon Suh Park
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung Geun Yeo
- Department of Otolaryngology, The College of Medicine, Kyung Hee University, Seoul, Korea
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Abstract
OBJECTIVES To compare the prognostic value of electroneurography (ENG) and needle electromyography (EMG) to estimate facial function outcome after acute facial palsy. STUDY DESIGN Retrospective study using electrodiagnostic data and medical chart review. METHODS Two hundred one patients treated 1995 to 2004 were included. Initial and final facial function was established clinically by the House-Brackmann (HB) scale. ENG results were classified into amplitude loss less than 75% and amplitude loss 75% or greater to predict complete recovery and defective healing, respectively. Initial and follow-up EMG results were classified into neurapraxia and predicted complete recovery. In contrast, axonotmesis/neurotmesis and mixed lesions predicted, by definition, defective healing. RESULTS : Initial HB was II to IV in 154 patients and V to VI in 47 patients. The etiology was idiopathic palsy in 139, iatrogenic lesion in 29, traumatic in 18, and herpes zoster in 15 patients. Finally, 134 (67%) patients showed a full recovery. Sixty-seven (33%) patients showed signs of defective healing. ENG presented a sensitivity, specificity, accuracy, positive predictive value (to predict defective healing), and negative predictive value of 60%, 79%, 73%, 59%, and 80%, respectively. The values for the initial EMG were 66%, 98%, 89%, 91%, and 89%. The best results showed the follow-up EMG with 85%, 100%, 97%, 100%, and 96%. EMG results were not classifiable in 32 (16%) patients. CONCLUSIONS EMG showed higher prognostic values than ENG, especially when repeated during the time course of the facial palsy. ENG might be helpful if the EMG result is not classifiable.
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Grosheva M, Guntinas-Lichius O. Significance of electromyography to predict and evaluate facial function outcome after acute peripheral facial palsy. Eur Arch Otorhinolaryngol 2007; 264:1491-5. [PMID: 17611766 DOI: 10.1007/s00405-007-0376-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2007] [Accepted: 06/12/2007] [Indexed: 11/28/2022]
Abstract
The prognostic value of electromyography (EMG) and its significance to estimate facial function outcome after acute facial palsy is still unclear. We retrospectively analysed the EMG reports of 494 patients with acute facial palsy treated from 1995 to 2005 in a tertiary referral centre. Initial and final facial functions were assessed by the House-Brackmann (HB) scale. Serial EMG results were classified into neurapraxia, axonotmesis/neurotmesis, mixed lesion, complete recovery, defective healing, or not classifiable. Initial HB was II-IV in 321 patients and V-VI in 173 cases. The aetiology was idiopathic palsy in 294, iatrogenic lesion in 86, traumatic in 52, Herpes zoster in 37, and of various origin in 25 patients. EMG revealed neurapraxia in 300 patients, axonotmesis/neurotmesis in 95 patients, and mixed lesion in 23 cases. EMG was not meaningful in 76 patients. The follow-up time ranged from 0.3-264 months. Final EMG revealed a full recovery in 160 patients, whereas 219 patients showed signs of defective healing. In 155 patients, EMG was not significant to classify the final outcome. The predictive EMG value for poor outcome was 77-86% and for recovery 53%. The mean EMG recovery time was 2.3 months. Mean time for defective healing was 4.3 months. Final HB was normal (HB I) in 323 patients, HB II-IV in 115 patients, and V-VI in 46 patients. We conclude that EMG has a high predictive value for unfavourable outcome after acute facial palsy. EMG is more sensible to detect signs of defective healing than clinical evaluation of facial function.
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Affiliation(s)
- Maria Grosheva
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany
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Wells J, Konrad P, Kao C, Jansen ED, Mahadevan-Jansen A. Pulsed laser versus electrical energy for peripheral nerve stimulation. J Neurosci Methods 2007; 163:326-37. [PMID: 17537515 PMCID: PMC2993156 DOI: 10.1016/j.jneumeth.2007.03.016] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 02/26/2007] [Accepted: 03/23/2007] [Indexed: 11/25/2022]
Abstract
Transient optical neural stimulation has previously been shown to elicit highly controlled, artifact-free potentials within the nervous system in a non-contact fashion without resulting in damage to tissue. This paper presents the physiologic validity of elicited nerve and muscle potentials from pulsed laser induced stimulation of the peripheral nerve in a comparative study with the standard method of electrically evoked potentials. Herein, the fundamental physical properties underlying the two techniques are contrasted. Key laser parameters for efficient optical stimulation of the peripheral nerve are detailed. Strength response curves are shown to be linear for each stimulation modality, although fewer axons can be recruited with optically evoked potentials. Results compare the relative transient energy requirements for stimulation using each technique and demonstrate that optical methods result in highly selective functional nerve stimulation. Adjacent stimulation and recording of compound nerve potentials in their entirety from optical and electrical stimulation are presented, with optical responses shown to be free of any stimulation artifact. Thus, use of a pulsed laser exhibits distinct advantages when compared to standard electrical means for excitation of muscle potentials in the peripheral nerve in the research domain and possibly for clinical diagnostics in the future.
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Affiliation(s)
- Jonathon Wells
- Vanderbilt University, Department of Biomedical Engineering, 5824 Stevenson Center, Nashville, TN 37235, United States
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