Acute Idiopathic Facial Paralysis Research Articles

Inpatient treatment of patients with acute idiopathic peripheral facial palsy: A population-based healthcare research study.

To determine the inpatient management for patients with acute idiopathic facial palsy (IFP) in Thuringia, Germany. Population-based study. All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012, in the German federal state, Thuringia. Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested. A total of 291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (odds ratio [OR=12.939; 95% confidence interval [CI]=3.599 to 46.516), gustatory testing (OR=6.878; CI=1.064 to 44.474) and audiometry (OR=32.505; CI=1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT (OR=0.192; CI=0.061 to 0.602), cerebrospinal fluid examination (OR=0.024; CI=0.006 to 0.102). A total of 131 patients (45%) showed a recovery to House-Brackmann grade≤II. A pathological stapedial reflex test (Hazard ratio [HR]=0.416; CI=0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500mg (HR=0.579; CI 0.400 to 0.838) and no adjuvant physiotherapy (HR=0.568; CI=0.407 to 0.794) were treatment-related predictors of worse outcome. Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials.

Quantitative evaluation of oral function in acute and recovery phase of idiopathic facial palsy; a preliminary controlled study

Patients with peripheral facial palsy frequently complain of fluid leakage and food retention during meals. We investigated oral function during eating in adults with peripheral facial palsy. A prospective two-phase controlled observational study. Data were collected at the ENT clinic in Nihon University Itabashi Hospital (patients) and Nihon University Dental Hospital (controls) between September 2009 and August 2011 and analysed at the Department of Oral Diagnostic Sciences in Nihon University School of Dentistry. Fourteen patients with acute idiopathic facial palsy and 14 controls completed Study 1. Sixteen patients with acute idiopathic facial palsy and 16 controls completed Study 2. In Study 1, oral vestibular cleansing capability was assessed by measuring the amount of rice remaining in the oral vestibule after mastication. In Study 2, masticatory efficiency was evaluated by measuring glucose eluted from gummy jelly during chewing. These oral functions were observed at the first visit and final visit (after patients with facial palsy had recovered). Oral vestibular cleansing capability at the first visit was significantly decreased by facial palsy (P < 0.001 versus healthy volunteers and P < 0.001 versus contralateral side) but recovered as facial muscular function improved (P = 0.034). There was a significant correlation between improvement in paralysis and decreased food retention (r = -0.528, P = 0.010). At the first visit, masticatory efficiency on the affected side was significantly lower than that of controls (P = 0.002) but had mostly recovered after resolution of facial palsy (P = 0.033). Oral functions were decreased by peripheral facial palsy. Oral vestibular cleansing capability was more significantly associated than masticatory efficiency with facial muscle function. Our data suggest that peripheral facial palsy impairs eating and worsens oral hygiene, which may result in oral disease.

Recurrent facial nerve palsy: the role of surgery

Repeated episodes of acute idiopathic facial paralysis present both a diagnostic and a management dilemma. We discuss these issues with reference to four adult cases managed between 1999 and 2008, thus adding to the sparse literature on this subject. For such cases, our unit performs decompression of geniculate, labyrinthine and meatal segments of the facial nerve via a middle fossa approach. A short video, available on The Journal of Laryngology & Otology website, demonstrates the key stages of the operation. We believe there is a role for surgical decompression in cases of recurrent acute facial weakness with three or more documented episodes, especially in the presence of progressive deterioration in function. Decompression of the geniculate, labyrinthine and meatal segments, via a middle fossa approach, is our favoured technique, and has achieved good results.

Aciclovir or valaciclovir for Bell's palsy (idiopathic facial paralysis).

The most common disorder of the facial nerve is acute idiopathic facial paralysis or Bell's palsy and there may be significant morbidity or incomplete recovery associated with severe cases. To assess the efficacy of aciclovir or similar agents for treating Bell's palsy. We searched the Cochrane Neuromuscular Disease Group register (searched April 2003), MEDLINE (from January 1966 to April 2003), EMBASE (from January 1980 to April 2003) and LILACS (from January 1982 to April 2003). We also contacted authors of identified trials. Randomised or quasi-randomised trials of aciclovir or valaciclovir therapy, alone or in combination with any other drug, in patients with Bell's palsy. We identified six randomised trials. Three studies met our inclusion criteria, including 246 patients. One study evaluated aciclovir with corticosteroid versus corticosteroid alone, another study evaluated aciclovir alone versus corticosteroid and a further study evaluated valaciclovir with corticosteroid versus corticosteroid alone or versus placebo alone. Incomplete recovery after one year: data were not available. An analysis was performed on data reported at the end of the study period in each trial. The results from one study four months after the start of treatment significantly favoured the treatment group, whilst the results of the study three months after the start of treatment significantly favoured the control group. The results from the second study at four months showed no statistically significant difference between the three groups. Adverse events: relevant data were not reported in any of the three trials. Complete facial paralysis six months after start of treatment: only one patient had complete paralysis upon entering one of the studies. This patient was assigned to the control group and the level of recovery attained was not reported. Motor synkinesis or crocodile tears one year after start of treatment: data were available up to a maximum of four months after onset of paralysis. One study reported a significant difference between the treatment groups in favour of the aciclovir plus corticosteroid group over corticosteroid alone, another demonstrated an inconclusive result with no difference between the aciclovir and corticosteroid. The third study did not comment upon these sequelae. More data are needed from a large multicentre randomised controlled and blinded study with at least 12 months' follow up before a definitive recommendation can be made regarding the effect of aciclovir or valaciclovir on Bell's palsy.

Lyme borreliosis and facial paralysis–a prospective analysis of risk factors and outcome

Purpose: To evaluate the incidence of Lyme borreliosis in patients with acute idiopathic facial paralysis with special emphasis on the risk factors that explain the poor outcome of facial paralysis and occurrence of Lyme borreliosis. Materials and Methods: During a 2-year period, we prospectively studied 503 consecutive patients with acute idiopathic facial paralysis for the presence of Lyme borreliosis. We screened the patients for antibodies to Borrelia burgdorferi and for symptoms or signs related to Lyme borreliosis. Chi-square and logistic regression tests were used for the statistical analysis. Special attention was paid to strict criteria for the diagnosis of Lyme borreliosis. Results: Eleven (2.2%) of the 503 patients with facial paralysis had Lyme borreliosis. Fever, headache, pharyngalgia, enlarged cervical lymph nodes, bilateral paralysis, and arthralgia were more common in patients with Lyme borreliosis than in those without it. In the logistic regression modeling the best combination of explanatory variables for predicting the occurrence of Lyme borreliosis included summer season at the onset of facial paralysis, presence of enlarged cervical lymph nodes, and arthralgia. The best combination of explanatory variables to predict the poor outcome of facial paralysis was total paralysis of facial nerves, recurrent facial paralysis, and hyperacusis. Conclusions: Lyme borreliosis is an important infectious cause of facial paralysis. In our study, 11 of 503 patients with acute idiopathic facial paralysis had Lyme borreliosis. The screening for serum antibodies in addition to the thorough evaluation of the history of the patient and of the patient's clinical signs or symptoms possibly linked with Lyme borreliosis, are essential when diagnosing Lyme borreliosis. (Am J Otolaryngol 2002;23:125-132. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Aciclovir for Bell's palsy (idiopathic facial paralysis).

The most common disorder of the facial nerve is acute idiopathic facial paralysis or Bell's palsy and there may be significant morbidity or incomplete recovery associated with severe cases. Although the cause remains unknown, recent evidence suggests a possible association with Herpes simplex virus (HSV) infection. To test this hypothesis clinically four clinical trials have used aciclovir, an antiviral agent, either alone or in combination with corticosteroids to treat Bell's palsy. To assess the efficacy of aciclovir for treating Bell's palsy and to evaluate any adverse effects of the drug treatment. Search of the Cochrane Neuromuscular Disease Group register, MEDLINE, EMBASE and LILACS databases for randomised trials. We also contacted authors of identified trials. Randomised or quasi-randomised trials of aciclovir therapy, alone or in combination with any other drug, in patients with Bell's palsy. We identified four randomised trials. One author extracted the data and the other checked them. We wrote to all the authors of the trials identified. No additional data were obtained. Only two studies met our inclusion criteria and provided results from 200 patients. One study evaluated aciclovir with corticosteroid versus steroid alone and the other study evaluated aciclovir alone versus corticosteroid. PRIMARY OUTCOME Proportion of patients with incomplete recovery after one year: These data were not available. However an analysis was performed on data reported at the end of the study period, three or four months after the start of treatment. The results from the Adour study significantly favoured the treatment group whilst the De Diego study significantly favoured the control group. Adverse events: This analysis was not performed as the data were not reported. Complete facial paralysis six months after start of treatment: Only one patient had complete paralysis upon entering only one of the studies. This patient was assigned to the control group and the level of recovery attained was not reported. Motor synkinesis/Crocodile tears one year after start of treatment: Data were available up to a maximum of four months after onset of paralysis. One study reported a significant difference between the treatment groups in favour of the aciclovir group and the other demonstrated an inconclusive result. More data are needed from a large multicentre randomised controlled and blinded study with at least 12 months' follow up before a definitive recommendation can be made regarding the routine use of aciclovir in Bell's palsy.

Antiphlogisitc-rheologic infusion therapy of acute idiopathic facial paralysis. Experiences and results of 344 cases

Antiphlogistic-rheologic infusion therapy is a widespread and well-established treatment modality for acute idiopathic facial paralysis (AIFP) in many German centers of otorhinolaryngology. However, there is still a lack of convincing data concerning this regimen's functional results and side effects. The medical records of 344 patients who were treated for AIFP between 1987 and 1997 were analyzed retrospectively. In 239 cases there was reliable information on functional outcome. Therapy consisted uniformly of intravenous infusion with prednisolone (250 mg initially, then tapering over 18 days) and simultaneous administration of dextran and pentoxifylline. From 239 patients with non-recurrent palsy having received treatment within 12 days after onset, 92.1% recovered completely without sequelae. In case of incomplete palsy (House-Brackmann grade II-V), normal facial function was restored in 97.7% of cases. Results were significantly better in the group in which therapy had been started within 3 days after onset of palsy. Adverse effects occurred rarely and were transient and mild in most cases. High-dose prednisolone in combination with low-molecular dextran and pentoxifylline for AIFP is a safe treatment modality leading to recovery rates superior to the most optimistic observations of the natural course of Bell's palsy. In the absence of a definitive controlled trial, the present study, although retrospective, is considered valid to show the effectiveness of our protocol. In the light of our data and of other publications, early treatment with corticosteroids in sufficient dosage seems appropriate, while therapeutic nihilism in AIFP does not seem justified.

Die idiopathische Fazialisparese

Although acute idiopathic facial paresis is often labelled "Bell's palsy", historical studies show that Nicolaus Anton Friedreich (1761-1836) from Würzburg was the first physician to describe the typical symptoms of the disorder in 1797, approximately 24 years prior to the paper published by Sir Charles Bell. Diagnostics has now improved to the extent that acute idiopathic facial palsy can more frequently be assigned to etiologies caused by inflammatory disorders. Herpes simplex virus type I and Borrelia burgdorferi are particularly relevant. Underestimation of the degree of paresis is, particularly in children, a drawback of the clinical examination. "Incomplete eyelid closure" is not a reliable indicator of remaining nerve function. For this reason complete electromyography (EMG) is recommended in all cases of severe facial paresis. Since electroneurography does not reliably reflect the degree of denervation present, needle EMG is preferred. The therapy of the facial palsy of unclear etiology is still not well defined. Nevertheless, we recommend that a combined treatment should be used early, at least in patients with disfiguring pareses. Combinations may consist of cortisone, virostatic agents and hemorrheologic substances and possibly antibiotics. Surgical decompression of the facial nerve remains controversial, since positive surgical results lack statistical support. Individual instructions for facial exercises, massage and muscle relaxation can support rehabilitation and possibly reduce the production of pathological synkinesia. Electrical stimulation should not be used. There are a number of possibilities available to reduce the effects of misdirected reinnervation, especially the use of botulinum-A-toxin. However, intensive diagnosis and therapy in the early phase of paresis are decisive in obtaining a favorable outcome. Further refinements in rehabilitation and comparative multicenter controlled studies are still required for future improvements in affected patients.

Evoked electromyography and idiopathic facial paralysis.

The purpose of this study was to standardize and evaluate the results of evoked electromyography (EEMG) in normal patients and in patients with acute idiopathic facial paralysis. A comparison of the amplitude of response to EEMG from one side of the face to the other in 288 normal patients yielded a great variability in results. The amplitude difference was not greater than 50%, and therefore a difference of less than 50% was considered normal. Test-retest variability of the percentage difference in amplitude in 10 subjects showed a 10% variation in seven patients and up to a 20% variation in the remaining three patients. Fifty patients with acute idiopathic facial paralysis were seen within 14 days of onset. A favorable prognosis was based on an EEMG amplitude of more than 25% of the normal side. With this criterion EEMG was accurate in predicting complete recovery in 36 (92%) of 39 patients. When EEMG was 25% of normal or less, incomplete recovery occurred in 9 (82%) of 11 patients. The response was 0% to 10% in six patients; four had a poor recovery and the remaining two had a fair recovery. The technique, interpretation of results, avoidance of pitfalls, and shortcomings of this test are discussed.

Recurrent facial palsy

During a 9-year period a total of 447 peripheral facial palsies was seen. Of the 377 cases of acute idiopathic facial palsy (AIFP) for which information was available, 41 (10.9%) were recurrent attacks. The final outcome is known for 346 (92%) of AIFPs. All patients were subjected to an extensive investigation protocol. No prognostic differences were found between primary and recurrent attacks of AIFP and complete recovery occurred just as frequently after recurrent palsies irrespective of whether these were ipsilateral or contralateral to the first attack. The incidence of recurrent AIFP was 2.03/100,000/year.