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Kwak MY, Lee HY, Lee SA, Jeong J, Chung JH, Kim J, Jun BC, Yeo SG, Kim SH, Lee JD. The Impact of the COVID-19 Pandemic on Bell's Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study. J Korean Med Sci 2024; 39:e140. [PMID: 38685888 PMCID: PMC11058340 DOI: 10.3346/jkms.2024.39.e140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This article presents a comprehensive review of data on the impact of facial palsy during the coronavirus disease 2019 (COVID-19) pandemic. The possible causes and pathophysiological mechanisms of changes in the epidemiology of facial palsy during the COVID-19 pandemic are also discussed. METHODS This multicenter retrospective cohort study included 943 patients diagnosed with Bell's palsy or Ramsay Hunt syndrome. This study compared patient demographics, comorbidities, symptoms, and treatments before the COVID-19 pandemic (from 2017 to 2019) and during the COVID-19 pandemic, from 2020 to 2022). RESULTS Following the COVID-19 outbreak, there has been a significant increase in the number of cases of Bell's palsy, particularly among elderly individuals with diabetes. Bell's palsy increased after the COVID-19 outbreak, rising from 75.3% in the pre-COVID-19 era to 83.6% after the COVID-19 outbreak. The complete recovery rate decreased from 88.2% to 73.9%, and the rate of recurrence increased from 2.9% to 7.5% in patients with Bell's palsy. Ramsay Hunt syndrome showed fewer changes in clinical outcomes. CONCLUSION This study highlights the impact of the COVID-19 pandemic on the presentation and management of facial palsy, and suggests potential associations with COVID-19. Notably, the observed increase in Bell's palsy cases among elderly individuals with diabetes emphasizes the impact of the pandemic. Identifying the epidemiological changes in facial palsy during the COVID-19 pandemic has important implications for assessing its etiology and pathological mechanisms of facial palsy disease.
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Affiliation(s)
- Min Young Kwak
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Ho Yun Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University Faculty of Medicine, Seoul, Korea
| | - Se A Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Junhui Jeong
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Ho Chung
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Kim
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Beom Cho Jun
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Geun Yeo
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Hoon Kim
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Jong Dae Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea.
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Babl FE, Eapen N, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Davidson A, Cheek JA, Oakley E, Hopper SM, Berkowitz RG, Wilson CL, Williams A, MacKay MT, Lee KJ, Hearps S, Dalziel SR. Pain in children with Bell's palsy: secondary analysis of a randomised controlled trial. Arch Dis Child 2024; 109:227-232. [PMID: 38049992 DOI: 10.1136/archdischild-2023-325381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To describe the prevalence and severity of pain experienced by children with Bell's palsy over the first 6 months of illness and its association with the severity of facial paralysis. METHODS This was a secondary analysis of data obtained in a phase III, triple-blinded, randomised, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children aged 6 months to <18 years conducted between 13 October 2015 and 23 August 2020 in Australia and New Zealand. Children were recruited within 72 hours of symptom onset and pain was assessed using a child-rated visual analogue scale (VAS), a child-rated Faces Pain Score-Revised (FPS-R) and/or a parent-rated VAS at baseline, and at 1, 3 and 6 months until recovered, and are reported combined across treatment groups. RESULTS Data were available for 169 of the 187 children randomised from at least one study time point. Overall, 37% (62/169) of children reported any pain at least at one time point. The frequency of any pain reported using the child-rated VAS, child-rated FPS-R and parent-rated VAS was higher at the baseline assessment (30%, 23% and 27%, respectively) compared with 1-month (4%, 0% and 4%, respectively) and subsequent follow-up assessments. At all time points, the median pain score on all three scales was 0 (no pain). CONCLUSIONS Pain in children with Bell's palsy was infrequent and primarily occurred early in the disease course and in more severe disease. The intensity of pain, if it occurs, is very low throughout the clinical course of disease. TRIAL REGISTRATION NUMBER ACTRN12615000563561.
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Affiliation(s)
- Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Nitaa Eapen
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Herd
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Perth, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Amit Kochar
- Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Emergency Department, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Ben Lawton
- Emergency Department, Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Andrew Davidson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia
| | - John A Cheek
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robert G Berkowitz
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Williams
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark T MacKay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Volk GF, Döhler M, Klinger CM, Weiss T, Guntinas-Lichius O. Sensory function in the faces of patients with facial palsy: A prospective observational study using quantitative sensory testing. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1041905. [PMID: 36600906 PMCID: PMC9806347 DOI: 10.3389/fpain.2022.1041905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Objectives/Hypothesis To determine the sensory function of both sides of the face in patients with acute or chronic facial palsy. Study design Prospective observational study. Methods The standardized quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain (DFNS), including thermal or mechanical stimuli (touch, pain, vibration, and pressure), was used to investigate somatosensory function in the faces of patients. A patient-reported outcome measures for the assessment of disturbed facial comfort or facial pain, the facial Clinimetric Evaluation Scale (FaCE) Facial Comfort Subscale, and the 36-Item Short Form Survey (SF-36) pain subdomain were used. Results A total of 29 patients (22 female, median age of 48 years; 7 acute palsy; 22 chronic palsy; House-Brackmann grade II-VI) were included. The median FaCE Facial Comfort Subscale score and the median SF-36 pain subdomain score were 50 and 100, respectively. Most patients had, at an individual level, a normal sensory function in all or most tests. On average, the frequencies for all parameters were not different between the paretic side and the contralateral side (all p > 0.05). Additionally, when z-scores were used to compare our patient sample with healthy controls from the DFNS reference database, there was no difference between the paretic side and the contralateral side (all p > 0.05). Furthermore, there were no differences between patients with acute facial palsy and those with chronic facial palsy (all p > 0.05). The FaCE Facial Comfort Subscale score and the SF-36 pain subdomain score did not correlate with the QST parameters (all p > 0.05). Conclusion Patients with acute or chronic unilateral peripheral facial palsy had normal sensory function on the paretic and contralateral sides compared with the reference values of healthy controls, and there was no significant difference between the sides. The numbness frequently felt in the affected hemiface is not related to a peripheral sensory disorder and is most likely a manifestation of an unsolved cortical somatosensory-motor mismatch.
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Affiliation(s)
- Gerd Fabian Volk
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany,Center for Rare Diseases, Jena University Hospital, Jena, Germany
| | - Marianna Döhler
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | | | - Thomas Weiss
- Department of Psychology, Clinical Psychology, Friedrich Schiller University, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany,Facial-Nerve-Center Jena, Jena University Hospital, Jena, Germany,Center for Rare Diseases, Jena University Hospital, Jena, Germany,Correspondence: Orlando Guntinas-Lichius
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