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Jamshidi A, Zonnour A, Dabiri S, Hasibi M, Tajdini A, Karrabi N, Yazdani N. Predictive role of facial nerve palsy improvement in malignant external otitis. Eur Arch Otorhinolaryngol 2024; 281:1253-1258. [PMID: 37725133 DOI: 10.1007/s00405-023-08230-3] [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: 06/17/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To evaluate the effects of different factors on facial nerve palsy improvement in patients with malignant external otitis (MEO) and the predictive role of improvement on MEO. METHODS Data were collected from all MEO patients with facial paralysis who were hospitalized between 2012 and 2017 at a tertiary referral center. We contacted patients at least 6 months after their admission to evaluate their facial nerve function and survival rate. RESULTS In a study of 19 samples with a mean age of 69.1 years, 9 patients (47.7%) had some or complete improvement, while 10 (52.6%) had no or very minimal improvement. In this study, there was no statistically significant difference between patients with and without facial nerve palsy improvement in terms of age, sex, usage of antifungal treatment alongside antibiotics, duration of hospital stays, HbA1c level, presentation of hearing loss and vertigo, the severity of facial palsy, comorbidity score, mean of fasting blood sugar, leukocytosis, first ESR and ESR drop, CRP and physiotherapy. We found a positive correlation between improving facial palsy and patients' survival rates. CONCLUSION Considering the possible influence of facial paralysis improvement prognosis on MEO patients' survival, it could affect our approach to the disease.
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Affiliation(s)
- Abolfazl Jamshidi
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, North Saadi Ave., Tehran, 11457-65111, Iran
| | - Alireza Zonnour
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, North Saadi Ave., Tehran, 11457-65111, Iran
| | - Sasan Dabiri
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, North Saadi Ave., Tehran, 11457-65111, Iran
| | - Mehrdad Hasibi
- Department of Internal Medicine (Infectious Diseases Division), Amir Alam Hospital, Tehran University of Medical Sciences, North Saadi Ave., Tehran, 11457-65111, Iran
| | - Ardavan Tajdini
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, North Saadi Ave., Tehran, 11457-65111, Iran
| | - Narges Karrabi
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, North Saadi Ave., Tehran, 11457-65111, Iran
| | - Nasrin Yazdani
- Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, North Saadi Ave., Tehran, 11457-65111, Iran.
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Rim HS, Byun JY, Kim SH, Yeo SG. Optimal Bell's Palsy Treatment: Steroids, Antivirals, and a Timely and Personalized Approach. J Clin Med 2023; 13:51. [PMID: 38202059 PMCID: PMC10779900 DOI: 10.3390/jcm13010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
IMPORTANCE The optimal treatment approach for patients with Bell's palsy, a condition characterized by acute facial nerve palsy, remains unclear. The present study was designed to provide insights into the most effective treatment strategies, whether steroids alone or steroids plus antiviral agents, as well as the optimal timing of treatment initiation. OBJECTIVE To investigate the impact of treatment modalities and timing on the recovery rates of Bell's palsy patients and to assess the roles of individual factors. DESIGN, SETTING, AND PARTICIPANTS This retrospective analysis included 1504 patients with Bell's palsy who visited Kyung Hee University Hospital. Patients were divided based on the treatment modality (steroid monotherapy vs. combined steroid and antiviral therapy) and the timing of treatment initiation (≤72 vs. >72 h). MAIN OUTCOMES AND MEASURES The primary outcome was the recovery rate, as assessed by the House-Brackmann (HB) grade. Secondary outcomes included factors such as age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions. RESULTS A combined comparison of patients treated with steroids plus antivirals and steroids alone, stratified by treatment start time, showed that recovery rates were highest in patients who received steroid monotherapy initiated within 72 h (OR 2.36; p < 0.05). Patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 h. The recovery rate was higher in patients who received steroid monotherapy than combined therapy (86.32% vs. 79.25%, p < 0.05). Initiating treatment beyond 72 h was associated with a higher recovery rate than starting treatment within 72 h (85.69% vs. 76.92%, p < 0.05). An evaluation of the factors affecting recovery showed that patients aged 20 to 39 years had a higher recovery rate than other age groups (OR 1.47; p < 0.05). Fairly predictive EMG results were associated with significantly higher recovery rates (OR 3.52; p < 0.05). CONCLUSIONS These findings underscore the importance of individualized treatment approaches in Bell's palsy management. Steroid monotherapy remains effective, although combined treatment may have potential advantages, especially in patients with more severe disease. The best treatment results were achieved when steroid treatment was administered within 72 h. Our results suggest that there may be more flexibility in the application of the 72 h treatment period if we consider the time of treatment initiation alone, but this should take into account patient behavior patterns and the limitations of retrospective analysis. Further research is warranted to validate these findings and refine treatment recommendations for patients with Bell's palsy.
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Affiliation(s)
| | | | | | - Seung Geun Yeo
- Department of Otorhinolaryngology—Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea; (H.S.R.); (J.Y.B.); (S.H.K.)
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Khan AJ, Szczepura A, Palmer S, Bark C, Neville C, Thomson D, Martin H, Nduka C. Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil 2022; 36:1424-1449. [PMID: 35787015 PMCID: PMC9510940 DOI: 10.1177/02692155221110727] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published between 01 January 2011 and 30 September 2020. METHODS Predetermined inclusion/exclusion criteria were utilised to shortlist abstracts. Two reviewers independently appraised articles, systematically extracted data and assessed the quality of individual studies and reviews (using GRADE and AMSTAR-2, respectively). Thematic analysis used for evidence synthesis; no quantitative meta-analysis conducted. The review was registered with PROSPERO (CRD42017073067). RESULTS Seven new randomised controlled trials, nine observational studies, and three quasi-experimental or pilot studies were identified (n = 854 participants). 75% utilised validated measures to record changes in facial function and/or patient-rated outcomes. High-quality trials (4/7) all reported positive impacts; as did observational studies rated as high/moderate quality (3/9). The benefit of therapy at different time points post-onset and for cases of varying clinical severity is discussed. Differences in study design prevented data pooling to strengthen estimates of therapy effects. Six new review articles identified were all rated critically low quality. CONCLUSION The findings of this targeted review reinforce those of the earlier more general Cochrane review. New research studies strengthen previous conclusions about the benefits of facial exercise therapy early in recovery and add to evidence of the value in chronic cases. Further standardisation of study design/outcome measures and evaluation of cost-effectiveness are recommended.
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Affiliation(s)
- Amir J Khan
- Department of Economics, Institute of Business
Administration, Karachi, Pakistan
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Ala Szczepura
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Shea Palmer
- Centre for Healthcare Research, Coventry University, Coventry, UK
- Centre for Care Excellence, Coventry University & University
Hospital Coventry & Warwickshire, Coventry, UK
| | - Chris Bark
- Lanchester Library, Coventry University, Coventry, UK
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - David Thomson
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - Helen Martin
- St Helens and Knowsley Teaching Hospitals
NHS Trust, Liverpool, UK
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
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Mul K, Wijayanto F, Loonen TGJ, Groot P, Vincenten SCC, Knuijt S, Groothuis JT, Maal TJJ, Heskes T, Voermans NC, Engelen BGMV. Development and validation of the patient-reported "Facial Function Scale" for facioscapulohumeral muscular dystrophy. Disabil Rehabil 2022; 45:1530-1535. [PMID: 35575310 DOI: 10.1080/09638288.2022.2066208] [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: 11/03/2022]
Abstract
PURPOSE Facial weakness and its functional consequences are an often underappreciated clinical feature of facioscapulohumeral muscular dystrophy (FSHD) by healthcare professionals and researchers. This is at least in part due to the fact that there are few adequate clinical outcome measures available. METHODS We developed the Facial Function Scale, a Rasch-built questionnaire on the functional disabilities relating to facial weakness in FSHD. A preliminary 33-item questionnaire was created based on semi-structured interviews with 16 FSHD patients and completed by 119 patients. For reliability studies, 73 patients completed it again after a two-week interval. Data were subjected to semi-automated Rasch analysis to select the most appropriate item set to fit model expectations. RESULTS This resulted in a 25-item unidimensional, linear-weighted questionnaire with high internal consistency (person separation index = 0.92) and test-retest reliability (patients' locations ICC = 0.98 and items' locations ICC = 0.99). Good external construct validity scores were obtained through correlation with the Communicative Participation Item Bank questionnaire, examiner-reported Facial Weakness Score and facial weakness subscale of the FSHD evaluation score (respectively r = 0.733, r = -0.566, and r = 0.441, all p < 0.001). CONCLUSIONS This study provides a linear-weighted, clinimetrically sound, patient-reported outcome measure on the functional disabilities relating to facial weakness in FSHD, to enable further research on this relevant topic.Implications for rehabilitationFacial weakness and its functional consequences are an often underappreciated clinical feature of facioscapulohumeral muscular dystrophy (FSHD), both in symptomatic treatment and in research.To enable the development and testing of therapeutic symptomatic interventions for facial weakness, clinical outcome measures are required.This study provides a linear-weighted, clinimetrically sound, patient-reported outcome measure on the functional disabilities relating to facial weakness in FSHD patients.
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Affiliation(s)
- Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Feri Wijayanto
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands.,Department of Informatics, Universitas Islam Indonesia, Yogyakarta, Indonesia
| | - Tom G J Loonen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Oral and Maxillofacial Surgery, Radboudumc 3D-Lab, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Perry Groot
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Sanne C C Vincenten
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simone Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Oral and Maxillofacial Surgery, Radboudumc 3D-Lab, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Tom Heskes
- Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Wihlidal JG, Bysice A, Rammal A, Yoo J, Matic D, Mendez A. Thematic Analysis of Canadian Patient-Reported Outcomes in Facial Nerve Paralysis: A Combined Interpretive Description and Modified Delphi Approach. Facial Plast Surg Aesthet Med 2022; 24:453-459. [DOI: 10.1089/fpsam.2021.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jacob G.J. Wihlidal
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Andrew Bysice
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Almoaidbellah Rammal
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Otorhinolaryngology—Head and Neck Surgery, King Abdul-Aziz University, Jeddah, Saudi Arabia
- Department of Medicine, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - John Yoo
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Damir Matic
- Department of Plastic and Reconstructive Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Adrian Mendez
- Department of Otolaryngology—Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Cho YS, Ryu O, Cho K, Kim D, Lim J, Hong SH, Cho YS. The effect of charge-balanced transcutaneous electrical nerve stimulation on rodent facial nerve regeneration. Sci Rep 2022; 12:1388. [PMID: 35082405 PMCID: PMC8791984 DOI: 10.1038/s41598-022-05542-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 12/30/2021] [Indexed: 01/23/2023] Open
Abstract
This study aimed to investigate the effect of charge-balanced transcutaneous electrical nerve stimulation (cb-TENS) in accelerating recovery of the facial function and nerve regeneration after facial nerve (FN) section in a rat model. The main trunk of the left FN was divided and immediately sutured just distal to the stylomastoid foramen in 66 Sprague–Dawley rats. The control group had no electrical stimulus. The other two groups received cb-TENS at 20 Hz (20 Hz group) or 40 Hz (40 Hz group). Cb-TENS was administered daily for seven days and then twice a week for three weeks thereafter. To assess the recovery of facial function, whisker movement was monitored for four weeks. Histopathological evaluation of nerve regeneration was performed using transmission electron microscopy (TEM) and confocal microscopy with immunofluorescence (IF) staining. In addition, the levels of various molecular biological markers that affect nerve regeneration were analyzed. Whisker movement in the cb-TENS groups showed faster and better recovery than the control group. The 40 Hz group showed significantly better movement at the first week after injury (p < 0.0125). In histopathological analyses using TEM, nerve axons and Schwann cells, which were destroyed immediately after the injury, recovered in all groups over time. However, the regeneration of the myelin sheath was remarkably rapid and thicker in the 20 Hz and 40 Hz groups than in the control group. Image analysis using IF staining showed that the expression levels of S100B and NF200 increased over time in all groups. Specifically, the expression of NF200 in the 20 Hz and 40 Hz groups increased markedly compared to the control group. The real-time polymerase chain reaction was performed on ten representative neurotrophic factors, and the levels of IL-1β and IL-6 were significantly higher in the 20 and 40 Hz groups than in the control group (p < 0.015). Cb-TENS facilitated and accelerated FN recovery in the rat model, as it significantly reduced the recovery time for the whisker movement. The histopathological study and analysis of neurotrophic factors supported the role of cb-TENS in the enhanced regeneration of the FN.
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Seminal Studies in Facial Reanimation Surgery: Consensus and Controversies in the Top 50 Most Cited Articles. J Craniofac Surg 2021; 33:1507-1513. [PMID: 34930875 DOI: 10.1097/scs.0000000000008436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Facial paralysis can impair one's ability to form facial expressions that are congruent with internal emotion. This hinders communication and the cognitive processing of emotional experience. Facial reanimation surgery, which aims to restore full facial expressivity is a relatively recent undertaking which is still evolving. Due in large part to published techniques, refinements, and clinical outcomes in the scientific literature, consensus on best practice is gradually emerging, whereas controversies still exist.Taking stock of how the discipline reached its current state can help delineate areas of agreement and debate, and more clearly reveal a path forward. To do this, the authors have analyzed the 50 seminal publications pertaining to facial reanimation surgery. In longstanding cases, the free gracilis transfer emerges as a clear muscle of choice but the nerve selection remains controversial with prevailing philosophies advocating cross facial nerve grafts (with or without the support of an ipsilateral motor donor) or an ipsilateral motor donor only, of which the hypoglossal and nerve to masseter predominate. The alternative orthodoxy has refined the approach popularized by Gillies in 1934 and does not require the deployment of microsurgical principles. Although this citation analysis does not tell the whole story, surgeons with an interest in facial reanimation will find that this is a good place to start.
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D'Souza AF, Rebello SR. Comparing the effectiveness of mime therapy and neuromuscular re-education in improving facial symmetry and function in acute Bell's palsy: a pilot randomised clinical trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2019.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims Untreated Bell's palsy may lead to disability and reduced quality of life, while early intervention can improve prognosis. This pilot randomised clinical trial aims to compare the effectiveness of mime therapy and neuromuscular re-education in improving facial symmetry and function in patients with acute Bell's palsy. Methods A total of 20 patients diagnosed with Bell's palsy were included in this study after meeting the inclusion criteria. Patients were randomly divided into two groups of ten. Group A received mime therapy while group B received neuromuscular re-education. Each participant received 12 sessions of the respective treatment over 2 weeks and was assessed for facial symmetry and function using the Sunnybrook Facial Grading System and the Facial Clinimetric Evaluation Scale respectively. Results Although both mime therapy and neuromuscular re-education showed highly significant improvements within each group for both the Sunnybrook Facial Grading System (P=0.005) and Facial Clinimetric Evaluation Scale (P=0.005); they showed no difference between each group for the Sunnybrook Facial Grading System (P=0.212) and Facial Clinimetric Evaluation Scale (P=0.97). Conclusions Mime therapy and neuromuscular re-education are equally effective in the recovery of facial symmetry and function in acute Bell's palsy. Physiotherapists can choose between either technique based on their skills and preference or based on patient comfort and expectation.
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Affiliation(s)
- Arnold Fredrick D'Souza
- Department of Physiotherapy, Father Muller College of Allied Health Sciences, Mangalore, Karnataka, India
| | - Sydney Roshan Rebello
- Department of Physiotherapy, Father Muller College of Allied Health Sciences, Mangalore, Karnataka, India
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Luu NN, Chorath KT, May BR, Bhuiyan N, Moreira AG, Rajasekaran K. Clinical practice guidelines in idiopathic facial paralysis: systematic review using the appraisal of guidelines for research and evaluation (AGREE II) instrument. J Neurol 2021; 268:1847-1856. [PMID: 33389026 DOI: 10.1007/s00415-020-10345-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 12/18/2022]
Abstract
Bell's palsy, or idiopathic facial paralysis, is a peripheral facial palsy of unknown cause that presents as sudden, unilateral weakness of the muscles of the face. Prompt treatment of Bell's palsy is critical in order for patients to achieve complete recovery of facial function. Delays in diagnosis and management can result in permanent facial defects. A number of clinical practice guidelines (CPG) exist to guide clinical decision-making in patients presenting with idiopathic facial paralysis. However, to date, there has been no comprehensive review of the methodological rigor and quality of these CPGs. Thus, the objective of the authors is to appraise the existing CPGs to ensure safe and effective practices. A total of eight guidelines met the inclusion criteria and were appraised. Only two CPGs achieved an overall rating of 'High', having five or more quality domains scoring > 60%. Across the CPGs, the domains of rigor of development, stakeholder involvement, and applicability has the lowest overall scores with 48.1%, 43.9%, and 43.1%, respectively. Based on the AGREE II instrument, the methodological rigor and quality of CPGs for Bell's palsy is low to average. In particular, future guidelines for Bell's palsy should look to the quality domains of rigor of development, stakeholder involvement, and applicability as the greatest opportunities for improvement.
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Affiliation(s)
- Neil N Luu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Kevin T Chorath
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Brandon R May
- University of Texas Health Science Center-San Antonio, Texas, USA
| | - Nuvid Bhuiyan
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA
| | - Alvaro G Moreira
- University of Texas Health Science Center-San Antonio, Texas, USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, 800 Walnut St, 18th Floor, Philadelphia, PA, 19010, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Cuenca-Martínez F, Zapardiel-Sánchez E, Carrasco-González E, La Touche R, Suso-Martí L. Assessing anxiety, depression and quality of life in patients with peripheral facial palsy: a systematic review. PeerJ 2020; 8:e10449. [PMID: 33344085 PMCID: PMC7718791 DOI: 10.7717/peerj.10449] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Peripheral facial palsy (PFP) is predominantly a unilateral disorder of the facial nerve, which can lead to psychological disorders that can result in decreased quality of life. The aim of this systematic review was to assess anxiety, depression and quality of life symptoms associated with PFP. DATA SOURCES We searched the Medline, PEDro, CINAHL and Google Scholar databases to conduct this systematic review while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. The search was performed by two independent reviewers, and differences between the two reviewers were resolved by consensus. STUDY SELECTION The search terms used were derived from the combination of the following MeSH terms: "facial paralysis", "bell palsy", "anxiety", "anxiety disorders", "depression", "depressive disorders", "quality of life" and not MeSH: "facial palsy", "hemifacial paralysis", "facial paresis", "Peripheral Facial Paralysis", using the combination of different Boolean operators (AND/OR). DATA EXTRACTION On November 1st (2019). DATA SYNTHESIS In total, 18 cross-sectional articles and two case-control studies were selected. CONCLUSIONS The cross-sectional articles showed low methodological quality, while the case-control studies showed acceptable methodological quality. Limited evidence suggests that patients with PFP might have increased levels of anxiety and depressive symptoms. A qualitative analysis also showed limited evidence that quality of life might be diminished in patients with PFP. PROSPERO CRD42020159843.
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Affiliation(s)
- Ferran Cuenca-Martínez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Eva Zapardiel-Sánchez
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrique Carrasco-González
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
- Departament of Physiotherapy, Universidad CEU Cardenal Herrera, CEU Universities, Valencia, Spain
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Szczepura A, Holliday N, Neville C, Johnson K, Khan AJK, Oxford SW, Nduka C. Raising the Digital Profile of Facial Palsy: National Surveys of Patients' and Clinicians' Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology. J Med Internet Res 2020; 22:e20406. [PMID: 32763890 PMCID: PMC7573702 DOI: 10.2196/20406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Facial nerve palsy leaves people unable to move muscles on the affected side of their face. Challenges exist in patients accessing facial neuromuscular retraining (NMR), a therapy used to strengthen muscle and improve nerve function. Access to therapy could potentially be improved through the use of digital technology. However, there is limited research available on patients' and clinicians' views about the potential benefits of such telerehabilitation based on their lived experiences of treatment pathways. OBJECTIVE This study aims to gather information about facial palsy treatment pathways in the United Kingdom, barriers to accessing NMR, factors influencing patient adherence, measures used to monitor recovery, and the potential value of emerging wearable digital technology. METHODS Separate surveys of patients with facial palsy and facial therapy specialists were conducted. Questionnaires explored treatment pathways and views on telerehabilitation, were co-designed with users, and followed a similar format to enable cross-referencing of responses. A follow-up survey of national specialists investigated methods used to monitor recovery in greater detail. Analysis of quantitative data was conducted allowing for data distribution. Open-text responses were analyzed using thematic content analysis. RESULTS A total of 216 patients with facial palsy and 25 specialist therapists completed the national surveys. Significant variations were observed in individual treatment pathways. Patients reported an average of 3.27 (SD 1.60) different treatments provided by various specialists, but multidisciplinary team reviews were rare. For patients diagnosed most recently, there was evidence of more rapid initial prescribing of corticosteroids (prednisolone) and earlier referral for NMR therapy. Barriers to NMR referral included difficulties accessing funding, shortage of specialist therapists, and limited awareness of NMR among general practitioners. Patients traveled long distances to reach an NMR specialist center; 9% (8/93) of adults reported traveling ≥115 miles. The thematic content analysis demonstrates positive attitudes to the introduction of digital technology, with similar incentives and barriers identified by both patients and clinicians. The follow-up survey of 28 specialists uncovered variations in the measures currently used to monitor recovery and no agreed definitions of a clinically significant change for any of these. The main barriers to NMR adherence identified by patients and therapists could all be addressed by using suitable real-time digital technology. CONCLUSIONS The study findings provide valuable information on facial palsy treatment pathways and views on the future introduction of digital technology. Possible ways in which emerging sensor-based digital technology can improve rehabilitation and provide more rigorous evidence on effectiveness are described. It is suggested that one legacy of the COVID-19 pandemic will be lower organizational barriers to this introduction of digital technology to assist NMR delivery, especially if cost-effectiveness can be demonstrated.
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Affiliation(s)
- Ala Szczepura
- Faculty Health & Life Sciences, Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Nikki Holliday
- Health & Life Sciences, Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
| | - Karen Johnson
- Facial Palsy UK (Charity), Peterborough, United Kingdom
| | - Amir Jahan Khan Khan
- Department of Economics,, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Samuel W Oxford
- Exercise & Life Sciences, Faculty Health & Life Sciences, Centre for Sport, Coventry University, Coventry, United Kingdom
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
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Watts P, Breedon P, Nduka C, Neville C, Venables V, Clarke S. Cloud Computing Mobile Application for Remote Monitoring of Bell's Palsy. J Med Syst 2020; 44:149. [PMID: 32725321 PMCID: PMC7387374 DOI: 10.1007/s10916-020-01605-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/15/2020] [Indexed: 12/31/2022]
Abstract
Mobile applications provide the healthcare industry with a means of connecting with patients in their own home utilizing their own personal mobile devices such as tablets and phones. This allows therapists to monitor the progress of people under their care from a remote location and all with the added benefit that patients are familiar with their own mobile devices; thereby reducing the time required to train patients with the new technology. There is also the added benefit to the health service that there is no additional cost required to purchase devices for use. The Facial Remote Activity Monitoring Eyewear (FRAME) mobile application and web service framework has been designed to work on the IOS and android platforms, the two most commonly used today. Results: The system utilizes secure cloud based data storage to collect, analyse and store data, this allows for near real time, secure access remotely by therapists to monitor their patients and intervene when required. The underlying framework has been designed to be secure, anonymous and flexible to ensure compliance with the data protection act and the latest General Data Protection Regulation (GDPR); this new standard came into effect in April 2018 and replaces the Data Protection Act in the UK and Europe.
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Affiliation(s)
- P Watts
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, UK
| | - P Breedon
- Medical Engineering Design Research Group, Nottingham Trent University, Nottingham, UK.
| | - C Nduka
- Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK
- Emteq Ltd, Sussex Innovation Centre, Brighton, UK
| | - C Neville
- Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK
| | - V Venables
- Queen Victoria Hospital, NHS Trust, East Grinstead, West Sussex, UK
| | - S Clarke
- Emteq Ltd, Sussex Innovation Centre, Brighton, UK
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Hotton M, Huggons E, Hamlet C, Shore D, Johnson D, Norris JH, Kilcoyne S, Dalton L. The psychosocial impact of facial palsy: A systematic review. Br J Health Psychol 2020; 25:695-727. [PMID: 32538540 DOI: 10.1111/bjhp.12440] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/11/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Facial palsy is a condition which can lead to significant changes in facial function and appearance. People with facial palsy often report psychosocial difficulties, including withdrawal from social activities, anxiety, negative body image, and low mood. This paper aimed to review all published research investigating the psychosocial impact of facial palsy on adults. METHODS A systematic search of MEDLINE, CINAHL, EMBASE, PsycINFO, and AMED databases was performed. The quality of included studies was assessed, and data were extracted with regard to characteristics of participants; study methodology and design; outcome measures used; and psychosocial outcomes. RESULTS Twenty-seven studies met inclusion criteria. A high proportion of people with facial palsy reported clinically significant levels of anxiety and depression, with greater difficulties typically reported by females, compared to males. Other difficulties consistently reported include low quality of life, poor social function, and high levels of appearance-related distress. Objective severity of facial palsy was consistently shown to not be associated with anxiety or depression, with psychological factors instead likely mediating the relationship between the severity of facial palsy and psychosocial well-being. CONCLUSIONS Irrespective of objective symptom severity, facial palsy has the potential to have a significant impact on psychosocial well-being and quality of life. The various methodological limitations of the included studies are discussed, along with clinical implications, including the need for greater access to psychological screening and interventions for people with facial palsy.
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Affiliation(s)
- Matthew Hotton
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Esme Huggons
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Claire Hamlet
- Centre for Appearance Research, University of the West of England, UK
| | - Danielle Shore
- Department of Experimental Psychology, University of Oxford, UK
| | - David Johnson
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Jonathan H Norris
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - Sarah Kilcoyne
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
| | - Louise Dalton
- Oxford Facial Palsy Service, Oxford University Hospitals NHS Foundation Trust, UK
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Parsa KM, Rieger C, Khatib D, White JR, Barth J, Zatezalo CC, Reilly MJ. Impact of early eyelid weight placement on the development of synkinesis and recovery in patients with idiopathic facial paralysis. World J Otorhinolaryngol Head Neck Surg 2020; 7:270-274. [PMID: 34632338 PMCID: PMC8486693 DOI: 10.1016/j.wjorl.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/20/2020] [Accepted: 05/15/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Determine the impact of upper eyelid weight placement at 3 months post onset of idiopathic facial paralysis (IFP) on the recovery of facial function in patients with lagophthalmos. Methods This is a retrospective review of patients with incomplete recovery of IFP-defined as a Sunnybrook Facial Grading Scale (FGS) score of less than 100, 3 months after onset. Only patients with FGS and Facial Clinimetric Evaluation (FaCE) scores recorded at 3 and 12 months were included. Patients were categorized into 3 groups: Group A, lagophthalmos with eyelid weight placement; Group B, lagophthalmos without eyelid weight placement; Group C, complete eye closure (CEC) without eyelid weight placement. The eye comfort domain and composite score of the FaCE questionnaire were analyzed. Voluntary eye closure, synkinesis with eye closure, overall synkinesis and the composite score of the FGS were also analyzed. Paired two-tailed t-test was used to evaluate the data comparing the 3 and 12 month FaCE and FGS scores within and between the 3 groups. Results The change in composite FGS score significantly increased from month 3 to month 12 in Group A as compared to Group B (37 vs 4.25, P = 0.01). While Group A had significantly lower eye comfort (-12.5, P = 0.01), voluntary eye closure (-1.75, P = 0.05) and overall FGS scores (-28.75, P = 0.04) at 3 months compared to those in Group C, there were no differences between these two groups at 12 month follow-up. Conclusions For patients with lagophthalmos at 3 months, early eyelid weight placement may lead to improved facial function at 12 months.
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Affiliation(s)
- Keon M Parsa
- Department of Otolaryngology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Caroline Rieger
- Department of Otolaryngology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Dara Khatib
- Department of Otolaryngology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jennifer R White
- Department of Otolaryngology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jodi Barth
- The Center for Facial Recovery, Rockville, MD, USA
| | - Chad C Zatezalo
- Department of Otolaryngology, MedStar Georgetown University Hospital, Washington, DC, USA.,The Zatezalo Group, Rockville, MD, USA
| | - Michael J Reilly
- Department of Otolaryngology, MedStar Georgetown University Hospital, Washington, DC, USA
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Sadiq SA, Pattinson R, Poole HM, Bundy C. Psychological distress and coping following eye removal surgery. Orbit 2019; 39:175-182. [PMID: 31573371 DOI: 10.1080/01676830.2019.1658789] [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: 10/25/2022]
Abstract
Purpose: Psychological distress is reasonably well documented in people with facial disfigurement; however, in patients following eye removal surgery this has not been studied adequately. We hypothesised that lower distress levels would be associated with age and more adaptive coping strategies and that women would be more likely to report higher levels of distress and, therefore, use maladaptive coping strategies.Methods: This exploratory, cross-sectional study measured distress and coping in a sample of 56 post enucleation or evisceration patients. The Hospital Anxiety and Depression Scale and the Brief COPE measured distress and coping strategies.Results: In all, 25.5% and 10.9% of the sample had high levels of anxiety and depression, respectively. Significant associations were found between levels of distress, coping strategies and demographic variables (p < .05). There were significant differences in coping strategies between those with higher and lower levels of distress (p < .05). Females reported higher levels of anxiety (U = 202.5, p < .01) and depression (U = 229, p < .05) than males. Those who experienced enucleation or evisceration aged between 20 and 39 years reported significantly higher levels of depression compared with other age groups (U = 68.5, p < .01).Conclusions: There was a relatively low level of distress across the whole sample, but we found high levels of distress in a considerable proportion (18.18%) of participants. Participants' coping strategies and levels of distress were correlated. Females and participants aged between 20 and 39 years at time of eye removal were particularly vulnerable to distress.
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Affiliation(s)
- S A Sadiq
- School of Natural Sciences and Psychology, Faculty of Science Liverpool John Moores University, Liverpool, UK.,Cataract & Oculoplastics, Manchester Royal Eye Hospital, Manchester, UK
| | - R Pattinson
- Faculty of Biology, Medicine & Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | - H M Poole
- School of Natural Sciences and Psychology, Faculty of Science Liverpool John Moores University, Liverpool, UK
| | - C Bundy
- Faculty of Biology, Medicine & Health, University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
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16
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Kashoo FZ, Alqahtani M, Ahmad M. Neural mobilization in Bell's palsy: A case report. Cranio 2019; 39:266-269. [PMID: 31043132 DOI: 10.1080/08869634.2019.1610996] [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: 10/26/2022]
Abstract
Background: Bell's palsy (BP) is a sudden onset of signs and symptoms of facial nerve dysfunction. The treatment of choice is corticosteroids and antiviral drugs. These drugs are risky for individuals with pre-existing conditions such as diabetes, high blood pressure, and digestive disturbances. Therefore, a beneficial complementary therapy would add to the success of treatment.Clinical Presentation: A 42-year-old male presented with left side facial paralysis and asymmetry. The patient received neural mobilization along with routine physical therapy for 1 hour, 5 days a week, for 3 weeks. A follow-up was scheduled at the 8th week.Clinical Relevance: Neural mobilization technique of the facial nerve is a novel and safe addition to the conservative treatment of BP.
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Affiliation(s)
- Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah, Saudi Arabia
| | - Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah, Saudi Arabia
| | - Mehrunnisha Ahmad
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah, Saudi Arabia
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Goo B, Jeong SM, Kim JU, Park YC, Seo BK, Baek YH, Yook TH, Nam SS. Clinical efficacy and safety of thread-embedding acupuncture for treatment of the sequelae of Bell's palsy: A protocol for a patient-assessor blinded, randomized, controlled, parallel clinical trial. Medicine (Baltimore) 2019; 98:e14508. [PMID: 30762782 PMCID: PMC6408039 DOI: 10.1097/md.0000000000014508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The sequelae of Bell's palsy cause critical problem in facial appearance, as well as social and psychological problems in the patient's life. The aim of the present study is to establish clinical evidence of thread-embedding acupuncture (TEA) in the treatment of sequelae of Bell's palsy. METHOD/DESIGN This is a patient-assessor blinded, randomized, sham-controlled trial with two parallel arms. Fifty-six patients aged 19-65 years, who have experienced sequelae of Bell's palsy for >3 months, will be recruited and screened using the eligibility criteria. After screening, they will be randomly allocated to a TEA group or a sham TEA (STEA) group. Both groups will receive TEA or STEA treatment on ten predefined acupoints once a week for 8 weeks. Additionally, both groups will receive the same acupuncture treatment twice a week for 8 weeks as a concurrent treatment. Changes in the Facial Disability Index over 8 weeks will be assessed as the primary outcome. Furthermore, the House-Brackmann Grade, Facial Nerve Grading System 2.0, Sunnybrook Facial Grading System, facial stiffness score, lip mobility score, and treatment satisfaction score will be measured and analyzed as secondary outcomes. All outcomes will be assessed at baseline and at 4 and 8 weeks after screening. DISCUSSION The results from this trial will help establish clinical evidence regarding the efficacy and safety of TEA in the treatment of patients with sequelae of Bell's palsy. TRIAL REGISTRATION NUMBER KCT0002557 (Clinical Research Information Service of the Republic of Korea).
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Affiliation(s)
- Bonhyuk Goo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul
| | - Seong-Mok Jeong
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul
| | - Jong-Uk Kim
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, 46, Eoeun-ro, Wansan-gu, Jeonju, Republic of Korea
| | - Yeon-Cheol Park
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul
| | - Byung-Kwan Seo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul
| | - Yong-Hyeon Baek
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul
| | - Tae-Han Yook
- Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital of Woosuk University, 46, Eoeun-ro, Wansan-gu, Jeonju, Republic of Korea
| | - Sang-Soo Nam
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul
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Deng Y, Xu Y, Liu H, Peng H, Tao Q, Liu H, Liu H, Wu J, Chen X, Fan J. Electrical stimulation promotes regeneration and re-myelination of axons of injured facial nerve in rats. Neurol Res 2018. [PMID: 29513163 DOI: 10.1080/01616412.2018.1428390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective To investigate the effects of electrical stimulation (ES) on the nerve regeneration and functional recovery of facial expression muscles in facial nerve defect rats. Methods Sixty rats were surgically introduced with a 1-cm defect on the right facial nerves and evenly divided into the Surgery group (Group A, the main trunk of the right facial nerve was surgically cut-off with a 1.0 cm at the foramina stylomastoideum) and the Surgery + ES group (Group B). Twenty normal rats were as normal control group (without receiving surgery or ES). For rats in group B, the orbicularis oris muscle of the right paralyzed face was stimulated with an electrical pulse of 3 V, 20 Hz and 0.3 mA for 1 h each day. The effects of ES on the facial muscle movement, compound muscle action potentials (CMAPs), histological structure, and the expression levels of S100B and NF200 proteins were comparatively studied. Results In group A, facial paralysis scores were slightly improved from day 1 to 28; the facial nerve trunks had swelled and malformed till day 14; and CMAPs could be induced in fewer animals and were abnormal, resulting in a slow recovery of the facial muscle movement. In group B, facial paralysis scores were improved from 4 to 2.6 during the 4 weeks; more rats showed a higher amplitude and shorter latency of CMAPs from day 14 to 28 after surgery; and increased axons and the expression of S100B and NF200 proteins and gradually decreased swelling in the injured facial nerve. Conclusion ES promotes outgrowth and myelination of axons and a partial functional recovery of facial muscles in injured facial nerve rats.
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Affiliation(s)
- Yue Deng
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Yaping Xu
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Huanhai Liu
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Hu Peng
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Qilei Tao
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Hongyi Liu
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Haibin Liu
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Jian Wu
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
| | - Xiaoping Chen
- b Department of Otolaryngology Head and Neck Surgery , Gongli Hospital, Second Military Medical University , Shanghai , China
| | - Jingping Fan
- a Department of Otolaryngology Head and Neck Surgery , Changzheng Hospital, Second Military Medical University , Shanghai , China
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Tseng CC, Hu LY, Liu ME, Yang AC, Shen CC, Tsai SJ. Bidirectional association between Bell's palsy and anxiety disorders: A nationwide population-based retrospective cohort study. J Affect Disord 2017; 215:269-273. [PMID: 28359982 DOI: 10.1016/j.jad.2017.03.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 03/01/2017] [Accepted: 03/24/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Bell's palsy and anxiety disorders share numerous risk factors (e.g., immune response, ischemia, and psychological stress). However, there have been no studies on the bidirectional temporal association between the two illnesses. In this study, we used the Taiwan National Health Insurance Research Database (NHIRD) to test the bidirectional association between Bell's palsy and anxiety disorders. We hypothesized that patients with Bell's palsy would have an increased risk of subsequent anxiety disorders later in life and that, conversely, those with anxiety disorders would have an increased likelihood of developing Bell's palsy later in life. METHODS We conducted two retrospective cohort studies using Taiwan's National Health Insurance Research Database (NHIRD). Study 1 included 8070 patients diagnosed with anxiety disorders and 32,280 controls without anxiety disorders who were matched with sex, age, and enrollment date to analyze the following risk of Bell's palsy among both groups. Study 2 included 4980 patients with Bell's palsy and 19,920 controls without Bell's palsy who were matched with sex, age, and enrollment date to analyze the following risk of anxiety disorders among both groups. The patient records selected for the studies were dated between January 1, 2000, and December 31, 2004. All subjects were observed until their outcomes of interest, death or December 31, 2009. RESULTS After adjustment for age, sex, comorbidities, urbanization, and income, the hazard ratio (HR) for patients with anxiety disorders to contract Bell's palsy was 1.53 (95% CI, 1.21-1.94, P<.001), and the HR for patients with Bell's palsy to develop an anxiety disorder was 1.59 (95% CI, 1.23-2.06, P<.001). CONCLUSION This study found a bidirectional temporal association between Bell's palsy and anxiety disorders. After one of these conditions develops, the morbidity rate for the other significantly increases. Additional studies are required to determine whether these two conditions share the same pathogenic mechanisms, and whether successfully treating one will reduce the morbidity rate for the other.
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Affiliation(s)
- Chih-Chieh Tseng
- Department of Psychiatry, Beitou branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mu-En Liu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Albert C Yang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Che Shen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
| | - Shih-Jen Tsai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
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Lee SMK, Lee S, Park JH, Park JJ, Lee S. A close look at an integrative treatment package for Bell's palsy in Korea. Complement Ther Clin Pract 2017; 26:76-83. [DOI: 10.1016/j.ctcp.2016.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 12/20/2016] [Indexed: 01/23/2023]
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Lee M, Mackay M, Blackbourn L, Babl FE. Emotional impact of Bell's palsy in children. J Paediatr Child Health 2014; 50:245-6. [PMID: 24674252 DOI: 10.1111/jpc.12541] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle Lee
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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Fu L, Bundy C, Sadiq SA. Psychological distress in people with disfigurement from facial palsy. Eye (Lond) 2011; 25:1322-6. [PMID: 21720412 PMCID: PMC3194312 DOI: 10.1038/eye.2011.158] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 05/06/2011] [Indexed: 11/09/2022] Open
Abstract
AIMS Psychological distress is well documented in people with facial disfigurement. However, the prevalence of psychological distress in patients with facial palsy has not been studied. This study aims to establish the prevalence of psychological distress and the extent of anxiety and depression in a sample of facial palsy patients from the Northwest of England. METHOD A total of 103 participants with facial palsy completed a questionnaire pack comprising the Illness Perception Questionnaire-Revised (IPQ-R), a demographic questionnaire, and the Hospital Anxiety and Depression Scale (HADS). The severity of participants' facial palsy was measured by the House-Brackmann scale. RESULTS In all, 32.7 and 31.3% of the sample had significant levels of anxiety and depression, respectively. The mean age of participants was 59, and 35.9% had grade 6 facial palsy. Significant associations were found between participants' perception of consequences, duration, timeline, and the level of distress. No significant associations were found between clinical severity of facial palsy and levels of distress. Females had significantly higher levels of anxiety compared with males. CONCLUSIONS There was a significant level of distress in this study group. The levels of psychological distress were higher than the levels found in other outpatient attenders. There were significant associations between participants' illness perceptions and their level of distress.
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Affiliation(s)
- L Fu
- School of Medicine, University of Manchester, UK
| | - C Bundy
- School of Medicine, University of Manchester, UK
| | - S A Sadiq
- Manchester Royal Eye Hospital, Manchester, UK
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Numthavaj P, Thakkinstian A, Dejthevaporn C, Attia J. Corticosteroid and antiviral therapy for Bell's palsy: a network meta-analysis. BMC Neurol 2011; 11:1. [PMID: 21208452 PMCID: PMC3025847 DOI: 10.1186/1471-2377-11-1] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 01/05/2011] [Indexed: 01/08/2023] Open
Abstract
Background Previous meta-analyses of treatments for Bell's palsy are still inconclusive due to different comparators, insufficient data, and lack of power. We therefore conducted a network meta-analysis combining direct and indirect comparisons for assessing efficacy of steroids and antiviral treatment (AVT) at 3 and 6 months. Methods We searched Medline and EMBASE until September 2010 using PubMed and Elsviere search engines. A network meta-analysis was performed to assess disease recovery using a mixed effects hierarchical model. Goodness of fit of the model was assessed, and the pooled odds ratio (OR) and 95% confidence interval (CI) were estimated. Results Six studies (total n = 1805)were eligible and contributed to the network meta-analysis. The pooled ORs for resolution at 3 months were 1.24 (95% CI: 0.79 - 1.94) for Acyclovir plus Prednisolone and 1.02 (95% CI: 0.73 - 1.42) for Valacyclovir plus Prednisolone, versus Prednisolone alone. Either Acyclovir or Valacyclovir singly had significantly lower efficacy than Prednisolone alone, i.e., ORs were 0·44 (95% CI: 0·28 - 0·68) and 0·60 (95% CI: 0·42 - 0·87), respectively. Neither of the antiviral agents was significantly different compared with placebo, with a pooled OR of 1·25 (95% CI: 0·78 - 1·98) for Acyclovir and 0·91 (95% CI: 0·63 - 1·31) for Valacyclovir. Overall, Prednisolone-based treatment increased the chance of recovery 2-fold (95% CI: 1·55 - 2·42) compared to non-Prednisolone-based treatment. To gain 1 extra recovery, 6 and 26 patients need to be treated with Acyclovir and prednisolone compared to placebo and prednisolone alone, respectively. Conclusions Our evidence suggests that the current practice of treating Bell's palsy with AVT plus corticosteroid may lead to slightly higher recovery rates compared to treating with prednisone alone but this does not quite reach statistical significance; prednisone remains the best evidence-based treatment.
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Affiliation(s)
- Pawin Numthavaj
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Gordon SC. Bell's palsy in children: role of the school nurse in early recognition and referral. J Sch Nurs 2009; 24:398-406. [PMID: 19114470 DOI: 10.1177/1059840508326258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bell's palsy is the most common condition affecting facial nerves. It is an acute, rapidly progressing, idiopathic, unilateral facial paralysis that is generally self-limiting and non-life threatening that occurs in all age groups (Okuwobi, Omole, & Griffith, 2003). The school nurse may be the first person to assess facial palsy and muscle weakness in children. Because facial palsy and muscle weakness may be an indicator of a serious or life threatening condition, the school nurse plays a critical role in early recognition and referral. The Gordon Facial Muscle Weakness Assessment Form is presented as a tool designed to assist school nurses in recognizing children with facial muscle weakness and in determining whether a primary health care provider referral should be considered immediate or urgent.
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Affiliation(s)
- Shirley C Gordon
- Christine E. Lynn College of Nursing, Florida Atlantic University, Port St. Lucie, FL, USA
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Alberton DL, Zed PJ. Bell's palsy: a review of treatment using antiviral agents. Ann Pharmacother 2006; 40:1838-42. [PMID: 16968821 DOI: 10.1345/aph.1h077] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the evidence evaluating the efficacy and safety of antiviral agents to reduce morbidity associated with Bell's palsy. DATA SOURCES MEDLINE, EMBASE, and PubMed were searched (all up to April 2006) for English-language, prospective, randomized, controlled clinical trials that evaluated the use of antiviral agents in Bell's palsy. Search terms included Bell's palsy, acyclovir, valacyclovir, famciclovir, and randomized controlled trials. STUDY SELECTION AND DATA EXTRACTION Prospective, randomized, controlled trials that evaluated efficacy and safety endpoints of antiviral agents in the treatment of Bell's palsy were included. Primary efficacy outcomes included facial paralysis recovery profile, facial paralysis recovery index, and the House-Brackmann facial nerve grading scale. Safety outcomes were also identified by each trial. DATA SYNTHESIS Two prospective, randomized clinical trials were included in this review, both involving the use of acyclovir for treatment of Bell's palsy. Acyclovir monotherapy was shown to be inferior to prednisone monotherapy; however, the combination of acyclovir and prednisone was found to be superior to prednisone alone. There are limited data describing the safety of acyclovir in Bell's palsy. CONCLUSIONS The use of acyclovir in the treatment of Bell's palsy remains controversial. Additional, adequately powered, randomized, placebo-controlled trials are needed to definitively support its use. For the time being, the evidence reviewed in this article would favor the combination of acyclovir and prednisone if commenced within the first 72 hours of symptom onset.
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Affiliation(s)
- Dario L Alberton
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Mitchell H. To smile again. Reanimation for unilateral facial palsy. BRITISH JOURNAL OF PERIOPERATIVE NURSING : THE JOURNAL OF THE NATIONAL ASSOCIATION OF THEATRE NURSES 2000; 10:16-21. [PMID: 11013060 DOI: 10.1177/175045890001000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
‘A smile adds a lot to your face value.’ Anon The above quotation is a reflection of the value placed by society on the humble smile. But for the person suffering from a facial paralysis, this simple act of expression is impossible.
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Keppel CC, Crowe SF. Changes to Body Image and Self-esteem following Stroke in Young Adults. Neuropsychol Rehabil 2000. [DOI: 10.1080/096020100389273] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rigby SA, Thornton EW, Tedman S, Burchardt F, Young CA, Dougan C. Quality of life assessment in MND: development of a social withdrawal scale. J Neurol Sci 1999; 169:26-34. [PMID: 10540004 DOI: 10.1016/s0022-510x(99)00212-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A scale to measure 'social withdrawal,' was developed specifically for use with MND patients. Scale design was based upon patient-focused interviews which were used to explore patients' concerns. The impact the condition had upon their social interactions with others was salient for all patients and affected their overall quality of life. Using issues raised by patients, a 23-item scale was generated to specifically and quantitatively measure social withdrawal and this scale was psychometrically evaluated. The scale was administered to a sample of 23 patients at varied stages of progression of MND, and to a control group of patients with arthritis with similar levels of physical disability. For MND patients withdrawal from the community was found to be closely related to severity of physical symptoms and depression. Specific patients were identified who are particularly susceptible to withdrawal and depression. Comparison of the pattern of withdrawal in the MND and arthritis patient groups suggested that there may be differences between the factors governing social withdrawal in different patient populations.
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Affiliation(s)
- S A Rigby
- Department of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, UK
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