Increased seroprevalence of Toxoplasma gondii in a population of patients with Bell’s palsy: a sceptical interpretation of the results regarding the pathogenesis of facial nerve palsy

Facial nerve oedema and anatomical predisposition to compression within the fallopian tube seem to be the only generally accepted facts in the pathophysiology of Bell’s palsy. Several infectious causes have been suggested as possible triggers of this oedema. Most of the suggested pathogens have been associated with facial nerve lesions during latent infections, reinfections or endogenous reactivations. The aim of this study was to investigate the seroprevalence of three such pathogens Toxoplasma gondii, Epstein–Barr virus (EBV) and cytomegalovirus (CMV) in a population of patients with facial nerve palsy. Fifty-six patients with Bell’s palsy were included in the study. A group of 25 individuals with similar age and gender distribution was used as control. Seropositivity for T. gondii, EBV viral capsid antigen (VCA) and CMV-specific IgM and IgG antibodies was investigated 2–5 days after the onset of the palsy. Comparisons for both IgM and IgG antibodies against T. gondii attributed significantly higher seroprevalence in the patients’ group than in the control group (p = 0.024 and 0.013, respectively). The respective examinations for EBV and CMV attributed no significant results. The roles of EBV and CMV in the pathogenesis of Bell’s palsy were not confirmed by this study. However, a significantly higher seroprevalence of IgM- and IgG-specific T. gondii antibodies was detected in patients with Bell’s palsy when compared to healthy controls. The possibility that facial nerve palsy might be a late complication of acquired toxoplasmosis may need to be addressed in further studies.     

Advances in diagnosis and non-surgical treatment of Bell’s palsy

Bell’s palsy is a commonly seen cranial nerve disease and can result in compromised facial appearance and functions. Its etiology, prognosis and treatment are still being debated. This paper is a review of recent development in the understanding of etiology, diagnosis and non-surgical treatment of Bell’s palsy.     

Acute peripheral facial palsy. Part of a cranial polyneuropathy?

In 14 of 16 consecutive patients with acute peripheral facial palsy, one or more (up to four) other nerves were involved. The nerves affected in addition to the facial nerve were as follows: trigeminal (ten patients), vestibular (eight), cochlear (six), vagus (one), and upper cervical (five). Virus was not isolated from any of the patients. A fourfold increase or decrease in complement-fixing antibody titers was present in eight patients (in four, varicella-zoster; in one, varicella-zoster and mumps; in two, cytomegalovirus; in one, mumps). Further, two of the patients with varicella-zoster antibodies showed clinical signs of herpes zoster oticus. About one fourth of all patients had an increase of ESR and of alpha2-globulins in serum, and two thirds of them had increased gamma-globulins in CSF. Acute peripheral facial palsy seems to be part of a cranial polyneuropathy and may be caused by a viral infection.     

The effect of metabolic syndrome on Bell’s palsy recovery rate

Objective: This study investigated the effects metabolic syndrome (MetS) and its factors such as diabetes mellitus (DM), hypertension (HTN), obesity, hypertriglyceridemia (high TG) and low high-density lipoprotein cholesterol (low HDL-C) on the recovery rate of patients with BP.

Methods: The medical records of 124 patients with BP were retrospectively reviewed. Patients were divided into a MetS group and a Non-MetS group according to the diagnostic criteria of MetS, and the demographic and clinical characteristics of the two groups at baseline and six months after BP onset were analyzed.

Results: Age was significantly higher in the MetS group than in the Non-MetS group (p?p?>?.05). The most common comorbidity of BP was high TG, followed by low HDL-C, HTN, obesity and DM. There were no differences in initial H–B grade in patients with and without each component of the MetS (p?>?.05). The recovery rate of BP was significantly lower in the MetS than in the Non-MetS group and was particularly affected by DM, obesity and high TG.

Conclusions: Recovery rate op BP is lower in patients with than without MetS.     

Prognostic factors of Bell’s palsy: prospective patient collected observational study

The purpose of this study was to evaluate various parameters potentially influencing poor prognosis in Bell’s palsy and to assess the predictive value for Bell’s palsy. A single-center prospective patient collected observation and validation study was conducted. To evaluate the correlation between patient characteristics and poor prognosis, we performed univariate and multivariate analyzes of age, gender, side of palsy, diabetes mellitus, hypertension, and facial grading score 1 week after onset. To evaluate the accuracy of the facial grading score, we prepared a receiver operating characteristic (ROC) curve and calculated the area under the ROC curve (AUROC). We also calculated sensitivity, specificity, positive/negative likelihood ratio, and positive/negative predictive value. We included Bell’s palsy patients who attended Ehime University Hospital within 1 week after onset between 1977 and 2011. We excluded patients who were less than 15 years old and lost-to-follow-up within 6 months. The main outcome was defined as non-recovery at 6 months after onset. In total, 679 adults with Bell’s palsy were included. The facial grading score at 1 week showed a correlation with non-recovery in the multivariate analysis, although age, gender, side of palsy, diabetes mellitus, and hypertension did not. The AUROC of the facial grading score was 0.793. The Y-system score at 1 week moderate accurately predicted non-recovery at 6 months in Bell’s palsy.     

The cost of foreign body injuries in the upper aero-digestive tract: need for a change from a clinical to a public health perspective?

OBJECTIVE: This paper addressed the impact in terms of direct costs of the injuries in children due to foreign bodies in the upper aero-digestive tract. METHODS: Two thousand one hundred and three consecutive cases were collected from 2000 to 2002 in 16 European hospitals, 1 hospital for each participating country, and referred to children aged until 14 who had FB injuries. Costs were based on the extraction of the FB procedures and on hospitalization length, based on DRGs. Determinants of costs and of length of stay (LOS) were analyzed using a multilevel model. RESULTS: The major cost of the treatment of FB injuries is covered by the ENT Departments, which are usually the first choice of referral, directly from the patients. Children had a mean LOS of 2.13 days (95% C.I. 1.99-2.29). Treatment of the FB was associated with a mean cost of euro 1017.37 (95% C.I. 963.27-1073.51). In the multivariable analysis higher costs are related to the modality of arrival to the hospital by walk, to the site of the injury (ICD-933, ICD-934, ICD-935 in particular) and to the use of surgery in removing the FB. DISCUSSION: Foreign bodies injuries are posing a great threat not only with regards to the clinical aspects but also from the public health perspective, their treatment being associated with high costs, in particular when surgery is needed.     

The relationship between Bell’s palsy and morphometric aspects of the facial nerve

Epidemiological data of Bell’s palsy (BP) have been reported. For example, the annual incidence of BP is 15–30 per 100,000 persons, with equal numbers of men and women affected, and there is no predilection for either side of the face. However, details of the relationship between BP and morphometric aspects of the facial nerve have not been available in textbooks. We performed a morphometric analysis of human facial nerve fibers and estimated the total number of myelinated axons (TN) and average transverse area of myelinated axons (ATA). The facial nerve showed a significant decrease of TN with increasing age (r = −0.77; p < 0.01), but showed no significant changes of ATA with age (r = −0.01; p = 0.96). We supposed that the TN decrease with age was a factor in the delayed recovery from BP seen in the elderly. Moreover, the TN and ATA showed no significant differences between female and male specimens (p < 0.05), or between the right and left side specimens (p < 0.05). Our present results seem to explain the absence of significant sex and affected side differences in BP.     

Ocular vestibular evoked myogenic potential testing for the prognosis of Bell’s palsy

Conclusion: oVEMP could be a useful tool for predicting the prognosis of Bell's palsy comparable to ENoG and H–B grade.

Objectives: Several previous studies have reported cases of Bell’s palsy with vestibular function disorder. The basic hypothesis behind this effect lies in the close proximity of the vestibular and facial nerves in the internal auditory canal (IAC). Therefore, the aim of this study was to investigate the correlation between Bell’s palsy prognosis and ocular vestibular evoked myogenic potentials (oVEMPs).

Methods: Total 104 consecutive patients who were diagnosed with Bell?s palsy from January 2012 to December 2014 were enrolled. Patients were divided into complete recovery group and incomplete recovery group. All of patients underwent oVEMP recordings within 1 week after disease onset. For the evaluation of correlation between H–B grades, ENoG, oVEMP and Recovery of Bell?s palsy, logistic regression analysis was performed.

Results: The mean value of ocular vemp asymmetry was significantly higher in the incomplete recovery group than the complete recovery group (p p?=?0.025, p?=?0.013, and p?相似文献   

Patients’ perceptions of vocal problems: results from a survey in the Tokyo area

Laryngoscopy in cases of sulcus vocalis reveals bowed vocal folds, resulting in a spindle-shaped chink with glottal incompetence. The anatomic and functional problems and resulting incomplete glottal closure during phonation lead to the presenting symptoms of breathy hoarseness, decrease in maximum phonation time (MPT), and vocal fatigue. These symptoms, however, have been reported from the physician’s viewpoint, not the patient’s. Furthermore, no standardized guidelines for the treatment of sulcus vocalis have been established. Because the general attitude toward sulcus vocalis appears to have become ‘It is only a vocal problem and does not significantly affect the patient’s well-being,’ knowledge of sulcus vocalis has decreased and knowledge about choices of therapy remain limited. We therefore conducted an epidemiological questionnaire survey on this pathological condition in voice clinics in seven hospitals in the Tokyo area to establish preliminary guidelines for the management of sulcus vocalis, in reference to the opinion of the patients. Here we report the summary of our preliminary study ‘a survey for sulcus vocalis’ and suggest guidelines for the management of such pathological conditions. Although these management guidelines may result in improvement in the symptoms of sulcus vocalis, patients and physicians should be aware that treatment of this condition is difficult and improvement is not guaranteed.     

Are corticosteroids useful in all degrees of severity and rapid recovery of Bell’s palsy?

Conclusions The results provide preliminary evidence that corticosteroids were not effective in all grades of dysfunction and for achieving a rapid remission in the early phase of BP, highlighting the need to define standard and rigorous criteria to prescribe corticosteroids in these patients. Objectives The main aim of this study was to investigate whether the use of corticosteroids better associated than paralleled with neuromuscular training (C?+?FNT) is more effective than facial neuromuscular training (FNT) applied alone, in terms of recovery degree and facial symmetry during the early phase of Bell’s palsy (BP). Patients and methods A prospective single-blinded study involved 73 patients: the C?+?FNT group (n?=?42; median age = 37.5 years) and FNT group (n?=?31; median age = 49.0 years). Patients were assessed before and 6 weeks after treatment by House-Brackmann (HB-FGS) and Sunnybrook Facial Grading System (SB-FGS). Results Recovery degree and facial symmetry improved significantly in both groups (p?p?>?0.05). However, the C?+?FNT group displayed better outcomes for cheek (p?=?0.004) and mouth (p?=?0.022) resting symmetry at SB-FGS, instead of compared to the FNT group. The corticosteroids had no significant effect on all recovery degrees (p?=?0.992) and rapid remission (p?=?0.952). Multiple linear regression analysis showed that the type of intervention was not a significant predictor for recovery degree (p?=?0.917).     

Prognostic value of the blink reflex test in Bell’s palsy and Ramsay-Hunt syndrome

Objective

This study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell’s palsy (BP) or Ramsay Hunt syndrome (RHS).

A comparative study of age and degree of facial nerve recovery in patients with Bell’s palsy

The purpose of this study was to investigate if there is any relationship between the age of a patient and the degree of facial nerve recovery in patients with Bell’s palsy. Between 1987 and 1995 250 patients with peripheral idiopathic facial nerve palsy were examined at the ENT Clinic of the University of Ioannina. In this group 134 were male and 116 were female. The patients’ ages ranged from 4 to 80 years and had an average of 47.7 years. The average age of the male patients was 46.5 years and that of the female patients was 49.1 years. In the overall group of 250 patients 129 presented with a paralysis of the right facial nerve and 121 on the left. There was no case of bilateral palsies. When comparing the age of the patients and the degree of recovery, measuring age was associated with a decrease in complete recovery. While the percentage of complete recovery between age 4 and 50 years varied from 83% to 74%, respectively, the percentage of complete recovery decreased to less than 54% at age 80. Our results show that the age of the patient is a very important factor for facial nerve recovery. Received: 22 October 1998 / Accepted: 27 February 1999     

The effect of subthreshold continuous electrical stimulation on the facial function of patients with Bell’s palsy

Conclusion: The drug regimen plus electrical stimulation was more effective in treating Bell’s palsy than the conventional drug treatment alone. The effectiveness of such a sub-threshold, continuous, low frequency electrical stimulation suggests a new therapeutic approach to accelerate nerve regeneration and improve functional recovery after injury. Objectives: The purpose of this study was to determine whether sub-threshold, continuous electrical stimulation at 20?Hz facilitates functional recovery of patients with Bell’s palsy. Materials and methods: The authors performed a prospective randomized study that included 60 patients with mild-to-moderate grade Bell’s palsy (HB grade ≤4, SB grade ≥40), to evaluate the effect of developed electrical stimulation on the resolution of symptoms. Thirty patients were treated with prednisolone or/and acyclovir plus electrical stimulation within 7 days of the onset of symptoms. The other 30 patients were treated with only prednisolone or/and acyclovir as a control group. Results: The overall rate of patient recovery among those treated with prednisolone or/and acyclovir plus electrical stimulation (96%) was significantly better (p?相似文献