Characteristics and Treatment Methods of Bell’s Palsy in Patients Visiting Korean Medicine Hospitals From August 2018 to July 2021

Background: The purpose of this study was to investigate the characteristics and direction of treatment for peripheral facial palsy (PFP) based on medical collaboration between Western and Korean medicine departments.<br/>Methods: There were 195 outpatients with PFP identified retrospectively by examining electronic medical records. These patients were treated with Korean and Western medicine from January 1st, 2018 to December 31st, 2018 at the Kyung Hee University hospital. Records were analyzed according to the patients’ demographic characteristics and clinical features of the collaborative combined treatment.<br/>Results: According to the collaborative treatment pathway, the number of patients consulted from Western medicine departments was more than consulted from Korean department for the first time. The time taken by the Western medicine departments to consult with the patients at the Korean center for the first time was 14.9 days from the onset of symptoms. Acupuncture was the most frequently used Korean medicine treatment. The total treatment period for Korean medicine sessions and intervals were 91.9 days, 23 times and 3.6 days, respectively. When the Korean medicine center consulted with Western medicine departments, the time taken until the first consultation was 8.5 days from the onset of symptoms. Medication was the most used treatment, prescribed after 3.1 days. The most frequently used clinical test was an electromyogram, and this was performed after 20.5 days. The total treatment period, sessions and intervals were 21.2 days, 2.8 times and 5 days, respectively.<br/>Conclusion: The clinical status of collaborative treatment for PFP was determined including the timing and interval of consultation according to treatments.

Facial paralysis due to cancer can be misdiagnosed as Bell's palsy. This study aims to clearly identify and quantify diagnostic differentiators and further evaluate the prognostic implications of misdiagnosis. Adult patients older than 18 years with facial palsy of unknown or cancerous etiology presenting between 2009 and 2023 were reviewed. Patient characteristics, examination findings, and clinical course were compared between facial paralysis patients with cancer misdiagnosed as Bell's palsy (Cancer-Bell's-Palsy group) and patients correctly diagnosed with Bell's palsy (Bell's-Palsy group). Additionally, morbidity and mortality were compared between facial paralysis patients with cancer initially misdiagnosed with Bell's palsy and facial paralysis patients initially correctly diagnosed with cancer (Cancer-Palsy group). Two-hundred and forty-three patients participated including 43 Cancer-Palsy, 18 Cancer-Bell's-Palsy, and 182 Bell's-Palsy patients. Cancer-Bell's-Palsy patients were significantly less likely than Bell's-Palsy patients to develop synkinesis (odds ratio [OR] = 0.0042; 95% confidence interval [CI]: [0.0005-0.0339]; p < 0.0001), significantly more likely to experience gradual onset facial paralysis (OR = 1,004.69; 95% CI: [54.40-18,555.77]; p < 0.0001), and significantly more likely to have additional nonfacial cranial nerve neuropathies (OR = 49.98; 95% CI: [14.61-170.98]; p < 0.0001). Cancer-Bell's-Palsy patients were more likely than Cancer-Palsy patients to have a greater than 6-month period from initial cancer-attributable symptom onset to cancer diagnosis (OR = 47.62; 95% CI: [9.26-250.00]; p < 0.001), stage IV cancer (OR: 12.36; 95% CI: 1.49-102.71; p = 0.006), and decreased duration of life after cancer diagnosis (median [interquartile range], 40.0 [87.0] vs. 12 [56.3] months, respectively; p = 0.025). Facial paralysis related to cancer must be differentiated from Bell's palsy, as misdiagnosis leads to delayed intervention and poorer prognosis. Gradual onset facial palsy, multiple cranial nerve neuropathies, lack of synkinesis, and lack of improvement were nearly definitive differentiators for underlying cancer.

Bell's palsy significantly impacts patients' quality of life, with approximately 30% not fully recovering. In South Korea, Korean Medicine (KM) is widely used as a complementary approach for facial palsy, with 50.86% of patients utilizing KM in 2021. Although quantitative studies have shown KM's effectiveness, there is a lack of research on lived experiences of the participants on KM treatment. We aim to identify the meaning of using KM among the patients with Bell's palsy. This study will be conducted in compliance with the consolidated criteria for reporting qualitative research. Patients with Bell's palsy who had or have received KM treatment and whose onset was less than two years prior to the interview date will be recruited by purposive and snowball sampling. One-on-one interviews will be conducted in person using a semi-structured interview guide. Interviews and recruitment will continue until meaning saturation is reached. The interviews will be conducted in South Korea in a private area near the patient's residence to make them feel comfortable. The data will be analyzed using Colaizzi's seven-step method. This study will explore the lived experiences of patients using KM for Bell's palsy and seek to understand the essence of their experiences. Utilizing Colaizzi's phenomenological approach, common themes in patients' experiences of receiving KM treatment will be uncovered. The findings are expected to provide valuable insights into healthcare professionals, potentially enhancing clinical practice and patient-centered care in the treatment of Bell's palsy.

Bell's palsy is a kind of peripheral neural disease that cause abrupt onset of unilateral facial weakness. In the pathologic study, it was evidenced that ischemia of facial nerve at the affected side of face existed in Bell's palsy patients. Since the direction of facial nerve blood flow is primarily proximal to distal, facial skin microcirculation would also be affected after the onset of Bell's palsy. Therefore, monitoring the full area of facial skin microcirculation would help to identify the condition of Bell's palsy patients. In this study, a non-invasive, real time and full field imaging technology - laser speckle imaging (LSI) technology was applied for measuring facial skin blood perfusion distribution of Bell's palsy patients. 85 participants with different stage of Bell's palsy were included. Results showed that Bell's palsy patients' facial skin perfusion of affected side was lower than that of the normal side at the region of eyelid, and that the asymmetric distribution of the facial skin perfusion between two sides of eyelid is positively related to the stage of the disease (P < 0.001). During the recovery, the perfusion of affected side of eyelid was increasing to nearly the same with the normal side. This study was a novel application of LSI in evaluating the facial skin perfusion of Bell's palsy patients, and we discovered that the facial skin blood perfusion could reflect the stage of Bell's palsy, which suggested that microcirculation should be investigated in patients with this neurological deficit. It was also suggested LSI as potential diagnostic tool for Bell's palsy.

Professional society guidelines provide clear recommendations regarding the use of high-dose steroids and/or antiviral therapy for Bell's palsy patients. This study evaluates national trends in the care of Bell's palsy patients and identifies current treatments. A retrospective cohort study of adult Bell's palsy patients was conducted using ICD-9-CM and ICD-10-CM diagnosis codes from 2013 to 2020. These patients were continuously enrolled in the employer-sponsored MarketScan commercial or Medicare outpatient and prescription drug claims data for at least 1 year. The main outcome of interest was prescription rates of high-dose steroids and antivirals after the diagnosis date. In this cohort of 66,708 adult Bell's palsy patients, 29,824 (44.7%) received no treatment. 22,736 (34.1%) received combination therapy, 11,866 (17.8%) received steroids only, and 2282 (3.4%) received antivirals only. Males were more likely to receive combination therapy. 51.9% of Bell's palsy patients in this cohort received the AAO-recommended treatment of steroids within 72 h of diagnosis. Patients in the Southern and Western United States were more commonly prescribed combination therapy. Comorbidities such as cerebrovascular disease and symptoms like ear pain were associated with a higher likelihood of receiving combination therapy. Treatment initiation, particularly for steroids, occurred on the index date, first insurance claim, in 94.56% of cases. Only 51.9% of Bell's palsy patients in this cohort received the AAO-recommended treatment with high-dose steroids with or without antiviral therapy. This research provides valuable insights into the real-world management of Bell's palsy, emphasizing the need for adherence to established treatment guidelines. N/A.

Immune-checkpoint inhibitors (ICIs) exposed the oncology community to novel immune-related adverse events (irAEs). Here, we report on a retrospective analysis of patients with melanoma who developed an ICI-related, unilateral, acute and peripheral facial nerve paralysis (Bell's palsy).We retrospectively reviewed all the cases of ICI-related Bell's palsy in patients with melanoma treated at our institution from January 2015 to January 2020. A total of five cases of ICI-related Bell's palsy were identified. Median age was 63 years. Median time-to-onset of Bell's palsy from ICIs initiation was 15 weeks. Four patients were treated with prednisone alone, whereas one patient was treated with prednisone plus valaciclovir. All the patients completely recovered from Bell's palsy without neurological sequelae. In melanoma patients treated with ICIs, Bell's palsy is a rare, neurologic irAE with a favorable outcome following administration of oral corticosteroids.

To evaluate the incidence of recurrent facial palsy and the frequency of misdiagnosis as Bell's palsy in patients with intratemporal facial nerve schwannomas (FNSs)Methods:A systematic review of PubMed and Cochrane databases and a single-institutional analysis were conducted, covering studies from the past 10 years on adult cases of intratemporal FNS with documented facial nerve function at presentation. Inclusion criteria focused on patients presenting with facial paralysis to assess recurrence rates and misdiagnoses as Bell's palsy. Key outcomes included incidence, severity, and the number of prior facial paralysis episodes at the time of FNS diagnosis. From 284 studies identified, 77 full texts were reviewed, and 53 met inclusion criteria, totaling 531 patients. Among the 531 patients, 55.6% (295) initially presented with facial paralysis. We found that 4.5% (24) of all patients in the systematic review and 22.2% (2) of cases in our institutional review with an intratemporal FNS were initially misdiagnosed with Bell's palsy. Of those who presented with facial paralysis, misdiagnosis as Bell's palsy was noted in 8.14% (24) of the systematic review and 100% (2) of our institutional review. The average House-Brackmann (HB) scores worsened from initial presentation to pre-operative assessment (mean scores: 2.07 ± 1.49 vs 2.94 ± 1.73). Our single-institutional and systematic review emphasizes that facial paralysis is a common presenting symptom of FNS. Although idiopathic (Bell's) palsy is the most frequent cause of facial paralysis, it remains a diagnosis of exclusion and a neoplastic cause should be ruled out in certain cases. A high index of suspicion is warranted for persistent (>3 months) or recurrent facial palsy, particularly when accompanied by otologic symptoms. Early identification of FNS enables timely interventions, such as facial nerve decompression, which may preserve native nerve function.

Contrast-enhanced MR images (at 1.5 T) were obtained in 11 patients with facial palsy. The group included five people with acute idiopathic facial (Bell's) palsy, three with chronic idiopathic facial palsy, and one each with acute facial palsy after local radiation therapy, acute facial palsy resulting from herpes zoster virus infection, and facial palsy caused by facial neuroma. Eight of the 11 patients demonstrated marked enhancement of the affected facial nerve from the labyrinthine portion through the descending canal. Three patients also demonstrated mild enhancement of the distal canalicular portion of the facial nerve, simulating small distal acoustic neuromas. No difference in the pattern of enhancement between the acute or chronic Bell's palsy patients was seen. Radiographic resolution appeared to lag behind clinical resolution. The facial neuroma appeared distinct from the other lesions as a focally enhancing mass. The enhancement pattern in the Bell's group correlated with the histopathologic features of Bell's palsy and is consistent with the viral hypothesis of the syndrome. Thin-section contrast-enhanced MR scans are recommended for individuals with atypical presentation of facial paralysis. In the proper clinical setting, contrast-enhanced MR imaging may permit a positive radiographic diagnosis of Bell's palsy, which has previously been a diagnosis of exclusion.

On the basis of alterations in varicella-zoster virus (VZV) antibody titers, it appears that Bell's palsy in some patients could be associated with VZV reactivation, that is, zoster sine herpete. To obtain stronger evidence of this association, polymerase chain reaction (PCR) was used to detect VZV DNA in auricular lesions or peripheral blood mononuclear cells (PBMCs) from Bell's palsy or Ramsay Hunt syndrome patients. VZV DNA was detected in the auricular lesions of Ramsay Hunt syndrome, in PBMCs from 2 Ramsay Hunt syndrome patients, and in 4 of 17 samples from 16 Bell's palsy patients. Three of these four positive patients were thought to have zoster sine herpete because of hearing difficulty, vertigo, and pain. VZV IgM antibodies were positive in 1 of the 2 patients with Ramsay Hunt syndrome, and in 2 of the 17 samples from the Bell's palsy patients. VZV IgG antibody titers during the acute phase were significantly higher in the patients positive for the PCR or VZV IgM antibody than in those negative for them. These findings provide evidence that Bell's palsy in some patients could be associated with VZV reactivation.

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Mucociliary transport (MCT) is an important defense mechanism of the respiratory tract. One of the major factors determining MCT is the ciliary activity of the respiratory epithelium. Rhinoscintigraphy is the most commonly used method for the analysis of mucociliary activity. The aim of this study was to investigate the effect of facial paralysis on the nasal mucociliary clearance. This study included 38 Bell's palsy patients as the study group and 10 subjects without any history of paranasal sinus disease or facial paralysis as the control group. A drop of technetium 99m-labeled macroaggregated albumin (Tc-99m MAA) was placed posterior to the head of the inferior turbinate and followed with a gamma camera. MCT rate was measured as the velocity of Tc-99m MAA drop. The mean MCT rate was 4.27 ± 0.76 millimeters per minute (mm/min) on 20 sides of 10 healthy controls, 4.11 ± 2.91 mm/min on the affected sides of the patients with Bell's palsy, and 6.03 ± 3.13 mm/min on the nonparalyzed sides of the patients. MCT rate was statistically significantly faster in the nonparalyzed side when compared to the paralyzed side in Bell's palsy patients (P = 0.001). MCT rates were not significantly different in the control group and paralyzed sides of the Bell's palsy patients (P = 0.810). The MCT rate was statistically significantly faster in the nonparalyzed sides of Bell's palsy patients when compared to the controls (P = 0.017). This study showed a faster MCT rate on the nonparalyzed side in Bell's palsy patients when compared to the paralyzed side and the control subjects. A compensatory mechanism could be the underlying reason for faster MCT on the nonparalyzed side. Further studies on larger patient groups are needed to investigate the effect of facial paralysis on the MCT and changes of facial nerve function on the opposite, nonparalyzed side of the face.

Factors associated with new-onset of mental health disorders in Bell's palsy patients: A MarketScan database study

Bell's palsy, which is defined as idiopathic peripheral facial paralysis of sudden onset, accounts for > 50% of all cases of facial paralysis. Different theories on the etiology of Bell's palsy have been proposed and investigated. Various clinical studies have suggested an etiological link between Bell's palsy and herpes simplex virus (HSV). In addition, animal experiments have shown the ability of HSV to induce facial paralysis. In our opinion, the possible link between Bell's palsy and HSV can only be explored properly by studying the human facial nerve, and especially the geniculate ganglion itself. Different groups have tried to detect hypothetically reactivated and hypothetically latent HSV in the facial nerves of Bell's palsy patients and control patients, respectively. The isolation of infectious HSV from facial nerve tissue by conventional cell culture methods appeared to be very difficult, also when Bell's palsy patients were tested. Instead, modern molecular methods, such as in situ hybridization and the polymerase chain reaction (PCR) could easily detect HSV DNA in geniculate ganglia. The detection of HSV-specific latency-associated transcripts in the ganglia of control patients provided further evidence for the hypothetically latent state of HSV in the geniculate ganglia in these patients. Recent PCR experiments performed by a Japanese group strongly suggest that the area adjacent to the geniculate ganglia does not usually contain any HSV at all, except in patients with Bell's palsy. This well-controlled study provides conclusive evidence that reactivation of HSV genomes from the geniculate ganglia is the most important cause of Bell's palsy. Consequently, it has been suggested that "Bell's palsy" be renamed as "herpetic facial paralysis".

Objectives The purpose of this study is to investigate the clinical characteristics in children and adolescents with peripheral facial palsy that was treated with Korean medicine. Methods The study was conducted based on 284 cases that consisted of 261 children (less than 19 years old) who visited the hospital of Korean medicine from August 2010 to August 2014. Then, this study was analyzed by reviewing the patients' charts. Results The incidence of facial palsy in pediatric patients was more common in boys than in girls and the mean age was 11.2 years. The prevalence of facial palsy was more common in winter and most were diagnosed with Bell's palsy. Recurrence was identified in 12.6% of the patients. The average age of the first attack was 9.5 years. It took about 3.2 years for recurrence to occur from the first onset. It took about 5 days to visit the hospital of Korean medicine from the onset. 81% of the patients came within 1 week from the onset. 50.7% of the cases did not receive any treatment before and 49.3% were previously treated at other hospitals. More than half of the patients (65.1%) received Korean medicine first. 54.6% of the patients were hospitalized and 45.4% received outpatient treatments in the hospital of Korean medicine. Outpatient treatments were administered about 11.5 times while hospitalized patients were treated for an average of 16.6 days. In general, hospitalized patients were treated more often than the outpatient group. An overall average duration of treatment was 70.6 days from the onset of facial palsy until the last day of treatment, and 53.0 days from the first day of treatment until the last day of treatment. 41.5% of the cases were treated only with Korean medicine and 49.0% were treated with a combination of Korean and Western medicine. The types of Korean medicine treatment used for facial palsy in descending order of frequency were acupuncture, Infra red, herbal medicine, SSP therapy, electro-acupuncture, carbone, hot pack, cupping, and moxibustion. The treatments that were most frequently used from Western medicines were steroid as monotherapy (61.7%) and a combination of steroids and antiviral therapy (37.6%). Conclusions This result showed that the risk of facial palsy recurrence among children is relatively high and that facial palsy requires a long-term treatment. It's helpful to explain about prognosis, treatment duration, and recurrence potential in children. Facial palsy in children is treated in various ways but more studies about the therapeutic effects of Korean medicine, Western medicine, and combination of Korean-Western medicine in children are needed.

Background and ObjectivesTo investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell's palsy.Subjects and MethodsThis study included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House-Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests.ResultsEGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls (p<0.05). In contrast, chemical taste tests showed no significant differences in taste thresholds between the two groups (p>0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests (p>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (p<0.05). In older individuals, however, no significant differences in taste thresholds were observed between Bell's palsy patients and healthy subjects (p>0.05).ConclusionsElectrical taste thresholds were higher in Bell's palsy patients than in controls. These differences were observed in younger, but not in older, individuals.