Abstract
In Bell’s palsy, electrodiagnosis by electroneurography (ENoG) is widely used to predict a patient’s prognosis. The therapeutic options for patients with poor prognostic results remain controversial. Here, we investigated whether early intervention with intratympanic steroid therapy (ITST) is an effective treatment for Bell’s palsy patients with poor electrodiagnostic test results (≤ 10% electroneurography value). Patients in the concurrent ITST group (n = 8) received the standard systemic dose of prednisolone (410 mg total) and intratympanic dexamethasone (16.5 mg total) and those in the control group (n = 21) received systemic prednisolone at the standard dose or higher (average dose, 605 ± 27 mg). A year after onset, the recovery rate was higher in the ITST group than in the control group (88% vs 43%, P = 0.044). The average House-Brackmann grade was better in the concurrent ITST group (1.13 ± 0.13 vs 1.71 ± 0.16, P = 0.035). Concurrent ITST improves the facial nerve outcome in patients with poor electroneurography test results, regardless of whether equivalent or lower glucocorticoid doses were administered. This may be ascribed to a neuroprotective effect of ITST due to a higher dose of steroid reaching the lesion due to dexamethasone transfer in the facial nerve.
Highlights
In Bell’s palsy, electrodiagnosis by electroneurography (ENoG) is widely used to predict a patient’s prognosis
It is widely accepted that this severity is most accurately evaluated by electroneurography (ENoG)[9], a technique originally developed by Esslen in 197710, which compares the maximum amplitude of the compound action potential of muscles innervated by the facial nerve to electrical stimulation on the ipsilateral and contralateral sides by stimulating the facial nerves at the stylomastoid foramen
We reported that early intervention with intratympanic steroid therapy (ITST) concurrently with standard therapy improves recovery in patients with Bell’s palsy[22]; the efficacy of ITST on patients with a poor electrophysiological result has not been determined
Summary
In Bell’s palsy, electrodiagnosis by electroneurography (ENoG) is widely used to predict a patient’s prognosis. Concurrent ITST improves the facial nerve outcome in patients with poor electroneurography test results, regardless of whether equivalent or lower glucocorticoid doses were administered This may be ascribed to a neuroprotective effect of ITST due to a higher dose of steroid reaching the lesion due to dexamethasone transfer in the facial nerve. Steroid treatment starting at an equivalent prednisolone dose of 30–60 mg/day is generally effective for facial nerve palsy that is moderately severe at worst, such that 71–96% of patients with Bell’s palsy are reported to have a favorable o utcome[3,4,5] This standard-of-care can be inadequate for patients with high-grade facial palsy, and many patients in this group suffer sequelae[6,7]. We investigated whether ITST is an effective therapeutic option to improve recovery for this subset of Bell’s palsy patients
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