Abstract
To establish whether clinical prognostic factor outcomes differed based on the initial severity of facial weakness and to determine the association between the initial severity of facial weakness and favorable outcomes. This retrospective cohort study analyzed all patients with Bell’s palsy who visited the outpatient clinic of our university hospital from 1 January 2005 through 31 January 2021. The primary outcome was the rate of recovery at 6 months, evaluated separately in patients with initial House–Brackmann (H-B) grades 3–4 and 5–6. Secondary outcomes included clinical factors associated with favorable outcomes stratified by the initial H-B grade. The rate of favorable recovery was higher in patients with initial H-B grades 3–4 than initial H-B grades 5–6 (82.9% vs. 68.2%, p < 0.001). Multivariable logistic regression analysis showed that age 19–65 years and good electromyography (EMG) results were prognostic of good outcomes in patients with initial H-B grades 3–4. In addition, good EMG results, controlled hypertension, and combination antiviral therapy were significantly prognostic of favorable outcomes in patients with initial H-B grades 5–6. Subgroup analysis interactions showed that combination antiviral therapy (OR: 3.06, 95% CI 1.62–5.78, p < 0.001) in initial H-B grades 5–6 were associated with more favorable outcomes at 6 months than with initial H-B grades 3–4. Our results showed that the proportion of patients who achieved favorable outcomes at 6 months and multiple clinical factors affecting favorable outcomes differed significantly among patients differing in initial severity of Bell’s palsy.
Highlights
Bell’s palsy is an idiopathic, acute peripheral facial neuropathy, which presents as unilateral weakness or paralysis of the face [1]
Our results showed that the proportion of patients who achieved favorable outcomes at 6 months and multiple clinical factors affecting favorable outcomes differed significantly among patients differing in initial severity of Bell’s palsy
Statistical Analyses The primary outcome was predefined as the percentage of patients achieving favorable outcomes 6 months after the onset of facial paralysis, as determined by H-B grade
Summary
Bell’s palsy is an idiopathic, acute peripheral facial neuropathy, which presents as unilateral weakness or paralysis of the face [1]. Many studies have assessed prognostic factors of outcomes, including accompanying symptoms, underlying diseases, such as hypertension and diabetes, age, and the degree of degeneration of the facial nerve as determined electrophysiologically. The initial degree of facial paralysis has been regarded as one of the most important prognostic factors for recovery [3]. The degree of initial facial paralysis is determined by the. House-Brackmann (H-B) grade, with lower H-B grade (less severe initial facial paralysis) being associated with a better prognosis. Few studies to date have assessed clinical factors associated with favorable outcomes in patients subgrouped by the degree of initial paralysis or initial severity of facial weakness. We hypothesized that clinical factors influencing favorable outcomes would differ by initial H-B grade
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