Investigation Of The Prognostic Value Of The Neutrophil/Lymphocyte Ratio In Bell Palsy

Abstract

Objectives:

Bell palsy (BP), also known as idiopathic facial paralysis, is a unilateral, acute-onset, isolated lower motor neuron weakness. It accounts for 60% to 75% of all cases of unilateral facial paralysis. The estimated annual incidence ranges between 11 and 40 per 100.000 people, with 40.000 new cases each year in different parts of the world. The neutrophil/lymphocyte ratio (NLR), calculated as the ratio of absolute neutrophil count to absolute lymphocyte count, is an easily measurable and inexpensive systemic inflammation marker. This study investigated the association between the NLR and BP by comparing clinical characteristics and functional outcomes of patients with BP and healthy controls.

Methods:

Thirty patients (24 women, 6 men) who presented to our clinic with BP between 2014 and 2016 were included in the study. The subjects underwent a general physical examination and an assessment of laboratory blood parameters. All patients were treated with prednisone, 1 mg/kg per day with a progressive dose reduction. The NLR was calculated as the simple ratio between absolute neutrophil and absolute lymphocyte counts.

Results:

The mean (SD) NLR values were 2.141 (0.80) in patients with BP and 1.41 (0.46) in the control group. The difference between groups was significant (p=0.0001).

There was a positive correlation between grade of facial paralysis and NLR values (r=0.663, p=0.0001). There was a positive correlation between prognosis of facial paralysis and NLR values (r=0.239, p=0.0251).

Conclusion:

The NLR was a valuable marker in BP patients in this study. Moreover, this study demonstrated a linear relationship between the NLR and BP severity and prognosis.

Keywords

• Bell Palsy; corticosteroids; neutrophils,lymphocytes

References

1. 1. Somasundara D, Sullivan F. Management of Bell’s palsy. Aust Prescr 2017;40:94-7.
2. 2. Adour KK, Byl FM, Hilsinger RL Jr, Kahn ZM, Sheldon MI. The true nature of Bell’s palsy: analysis of 1,000 consecutive patients. Laryngoscope 1978;88:787-801.
3. 3. Greco A, Gallo A, Fusconi M, Marinelli C, Macri GF, de Vincentiis M. Bell’s palsy and autoimmunity. Autoimmun Rev 2012;12:323-8.
4. 4. Patel DK, Levin KH. Bell palsy: Clinical examination and management. Cleve Clin J Med 2015;82:419-26.
5. 5. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012:26;5:2.
6. 6. Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 2012;19:217-24.
7. 7. Jung MR, Park YK, Jeong O, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol 2011;104:504-10.
8. 8. Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol 2011;107:433-8.

9. 9. Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail 2012;34:155-9. References
10. 10. Torun S, Tunc BD, Suvak B, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol 2012;36:491-7.
11. 11. Seo YJ, Jeong JH, Choi JY, Moon IS. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: novel markers for diagnosis and prognosis in patients with idiopathic sudden sensorineural hearing loss. Dis Markers 2014;2014:702807.
12. 12. Chung JH, Lim J, Jeong JH, Kim KR, Park CW, Lee SH. The significance of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in vestibular neuritis. Laryngoscope 2015;125:257-61.
13. 13. Bucak A, Ulu S, Oruc S, Yucedag F, Tekin MS, Karakaya F. Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy. Laryngoscope 2014;124: 1678–81.
14. 14. Özler GS, Günak G. Neutrophil-lymphocyte ratio: a new predictive and prognostic factor in patients with Bell palsy. J Craniofac Surg 2014;25:944-5.
15. 15. Kasse CA, Cruz OL, Leonhardt FD, Testa JR, Ferri RG, Viertler EY. The value of prognostic clinical data in Bell’s palsy. Braz J Otorhinolaryngol 2005;71:454-8.
16. 16. Ushio M, Kondo K, Takeuchi N, Tojima H, Yamaguchi T, Kaga K. Prediction of the prognosis of Bell’s palsy using multivariate analyses. Otol Neurotol 2008;29:69-72.