HYPERBARIC OXYGEN THERAPY (HBOT)

Abstract

The role of steroids in the treatment of Bell’s palsy is well known provided patientspresent within 72hrs of symptoms onset. If patients present late or with severe Bell’s palsythe effect of steroids or other treatment modalities is not yet clear. Aim of this study was toevaluate the effect of HBOT along with oral steroids in treatment of such patients. Setting:Diving department at Armed Forces Hospital King Abdul Aziz Naval Base Jubail, Kingdom ofSaudi Arabia (KSA). Period: January 2010 to Dec. 2015. Methods: Bell’s palsy patients ofage 13 years and above were treated with steroids & HBOT. Prednisolone 60mg was givenorally for one week to all patients & those patients who could tolerate HBOT were selected fortreatment with Hyperbaric Oxygen in a closed chamber at 2.5 ATA, 90 minutes a day and fivedays a week. HBOT was continued till complete recovery or up to 20 sessions before declaringpartial recovery or failure. Assessment was done by physician using House-Brackmanngrading system for Facial nerve dysfunction. Patients were followed up to 3 months beforedeclaring partial recovery or treatment failure. Results: Treatment was started on 125 patientsbut 15 patients could not tolerate HBOT due to ear pain (10 patients) or high blood pressure(5 patients) in the HBOT chamber whereas 10 patients did not show up for follow up so only100 patients completed the treatment. Out of 100, 22(22%) patients had mild (grade I to II), 40patients (40%) had moderate (grade III to IV) and 38 patients (38%) had severe (grade V to VI)Bell’s palsy. Majority of patients (85%) presented after 72hrs of symptoms onset. At 3 monthsof follow up 90% (n=90) patients had full recovery whereas 10% (n=10) patients had partialrecovery. Severity of disease (OR 0.125, CI 0.025---0.6255, p =0.00595) and time between onsetof symptoms and start of treatment >2weeks (OR 0.0966 CI 0.0187---0.4987, p=0.00280) werestatistically significant. Conclusion: Combination of Hyperbaric Oxygen therapy and steroids is