EFFECT OF INTRATYMPANIC DEXAMETHAZONE ON BELL'S PALSY: LETTER TO THE EDITOR.

Abstract

To the Editor: We read the article on “Concurrent Treatment With Intratympanic Dexamethasone for Moderate-Severe Through Severe Bell's Palsy” (1) with great interest. Concluded that “The recovery rate was higher for concurrent intratympanic steroid therapy treatment than for standard-of care control treatment.” We would like to share ideas on this report. Due to reports, Volk et al. (2) and Engström et al. (3) which is in the discussion section of their article (1), the recovery rate was 73 and 72% when the median value of the most severe HB grade was midway between grades III and IV. It seems to be a statistically confounding factor in report of Inagaki et al. (1). And that's it with this number of patients entering the intervention group, no significant and meaningful result can be obtained. Because patients who have been in the intervention group may be the ones who get better even without any drugs. Also, regarding the routes of dexamethasone delivery to the facial nerve, it is noted that there is a blood vessel pathway between the tympanic vascular branches and the vascular branches on the facial nerve (1). We know that regardless of the primary etiology of Bell's palsy, which has remained unknown until now, the increased pressure caused by inflammation and swelling of the nerve inside the fallopian canal causes ischemia and consequently paresis or paralysis of the facial nerve. Therefore, it is expected that these vessels will be closed when an ischemia occurs and that there is no way to delivery the drug (dexamethazone). Therefore, additional studies with larger volume for investigating the effect of intratympanic dexamethasone on Bell's palsy are required.