Clinical prognostic factors in patients with idiopathic peripheral facial nerve paralysis (Bell’s palsy)

Yıl 2017, Cilt: 3 Sayı: 2, 170 - 174, 04.07.2017

Fatih Alper Akcan Yusuf Dundar Ahmet Uluat Hakan Korkmaz Ali Ozdek

https://doi.org/10.18621/eurj.293246

Cited By: 2

Öz

Objective. The aim of this study was to analyse the clinical prognostic factors that are associated with treatment outcomes in patients with idiopathic peripheral facial nerve paralysis (PFNP). Methods. The study was performed retrospectively with 80 patients in a tertiary medical center. All of the patients were treated and followed for idiopathic PFNP (Bell’s palsy). The patient charts were reviewed for patient demographics and characteristics. The comorbidities (hypertension, diabetes mellitus), the side, grade and duration of palsy, and the acoustic stapedius reflex were analysed. Results. Forty-three male and 37 female patients were diagnosed with idiopathic PFNP. Sixty-seven of patients had complete, 13 patients had partial recovery. Of the partial recoveries, 12 patients had Grade 2 and one patient Grade 3 PFNP at the end of primary treatment. Patients tended to have incomplete recovery if they have a diagnosis of diabetes mellitus, but the difference between groups was not statistically significant (p=0.326). A positive stapedius reflex was associated with complete recovery (p=0.023). Patients had much more risk of incomplete recovery if age is more than 40 years (p=0.006). Conclusion. A detailed history and complete physical examination are very important in peripheral facial palsy. Co-morbid diseases and demographic features such as high blood pressure, diabetes mellitus and advanced age might influence the treatment outcomes.

Anahtar Kelimeler

Facial paralysis, Bell’s palsy, seventh nerve paralysis, risk factors, prognosis

Kaynakça

• [1] Adour KK, Hilsinger RL Jr, Callan EJ. Facial paralysis and Bell’s palsy: a protocol for differential diagnosis. Am J Otol 1985;Suppl: 68-73.
• [2] Rowlands S, Hooper R, Hughes R, Burney P. The epidemiology and treatment of Bell’s palsy in the UK. Eur J Neurol 2002;9:63-7.
• [3] Taverner D. The prognosis and treatment of spontaneous facial palsy. Proc R Soc Med 1959;52:1077-80.
• [4] Adour KK, Bell DN, Hilsinger RL Jr. Herpes simplex virus in idopathic facial paralysis (Bell’s palsy). JAMA 1975;233:527-30.
• [5] Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell’s palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med 1996;124:27-30.
• [6] McCormick D. Herpes-simplex virus as a cause of Bell’s palsy. Lancet 1972;1:937-9.
• [7] Grose C, Henle W, Henle G, Feorino PM. Primary-Epstein-Barr-virus in acute neurologic disease. N Engl J Med 1975;292:392-5.
• [8] Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;549:4-30.
• [9] Adour KK, Wingerd J, Bell DN, Manning JJ, Hurley JP. Prednisone treatment for idiopathic facial paralysis (Bell’s) palsy. N Engl J Med 1972;287:1268-72.
• [10] Abraham-Inpijn L, Oosting J, Hart AA. Bell’s palsy: factors affecting the prognosis in 200 patients with reference to hypertension and diabetes mellitus. Clin Otolaryngol Allied Sci 1987;12:349-55.
• [11] Marsk E, Bylund N, Jonsson L, Hammarstedt L, Engstrom M, Hadziosmanovic N, et al. Prediction of nonrecovery in Bell’s palsy using Sunnybrook grading. Laryngoscope 2012;122:901-6.
• [12] Takashi F, Naohito H, Kiyofumi G, Naoaki Y. Prognostic factors of Bell’s palsy: prospective patient collected observational study. Eur Arch Otorhinolaryngol 2014;271:1891-5.
• [13] Takemoto N, Horii A, Sakata Y, Inohara H. Prognostic factors of peripheral facial palsy: multivariate analysis followed by receiver operating characteristic and Kaplan-Meier analyses. Otol Neurotol 2011;32:1031-6.
• [14] Kerbavaz RJ, Hilsinger RL, Adour KK. The facial paralysis prognostic index. Otolaryngol Head Neck Surg 1983;91:284-9.
• [15] Mancini P, De Seta D, Prosperini L, Nicastri M, Gabriele M, Ceccanti M, et al. Prognostic factors of Bell’s palsy: multivariate analysis of electrophysiological findings. Laryngoscope 2014;124:2598-605.
• [16] Hato N, Fujiwara T, Gyo K, Yanagihara N. Yanagihara facial nerve grading system as a prognostic tool in Bell’s palsy. Otol Neurotol 2014;35:1669-72.
• [17] Prim MP, De Diego JI, Sanz O. Prognostic Factors with Idiopatic Facial Paralysis. ORL J Otorhinolaryngol Relat Spec 1999;61:212-4.
• [18] Smith IM, Cull RE. Bell’s palsy-which factors determine final recovery? Clin Otolaryngol 1996;19:465-6.
• [19] Kanazawa A, Haginomori S, Takamaki A, Nonaka R, Araki M, Takenaka H. Prognosis for Bell's palsy: a comparison of diabetic and nondiabetic patients. Acta Otolaryngol 2007;127:888-91.
• [20] Wasano K, Kawasaki T, Yamamoto S, Tomisato S, Shinden S, Ishikawa T, et al. Pretreatment hematologic findings as novel predictive markers for facial palsy prognosis. Otolaryngol Head Neck Surg 2016;155:581-7.
• [21] Citron D, Adour K. Acoustic reflex and loudness discomfort in acute facial paralysis. Arch Otolaryngol 1978;104:303-6.
• [22] Peitersen E. The natural history of Bell's palsy. Am J Otol 1982;4:107-11.
• [23] Jabor MA, Gianoli G. Management of Bell's palsy. J La State Med Soc 1996;148:279-83.
• [24] Gronseth GS, Paduga R, American Academy of Neurology. Evidence-based guideline update: steroids and antivirals for Bell palsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2012;79:2209-13.
• [25] Engstrom M, Berg T, Stjernquist-Desatnik A, Axelsson S, Pitkaranta A, Hultcrants M, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2008;7:993-1000.
• [26] Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K, et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol 2007;28:408-13.