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.     

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).

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).     

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 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.     

Electroneurography value as an indicator of high risk for the development of moderate-to-severe synkinesis after Bell’s palsy and Ramsay Hunt syndrome

Abstract

Background: The degree of distress caused by the sequelae of peripheral facial nerve palsy usually depends on the severity of synkinesis.

Objective: To clarify whether electroneurography (ENoG) can predict the severity of synkinesis after peripheral facial nerve palsy.

Materials and methods: One-hundred and fourteen patients treated for facial nerve palsy at our hospital from April 2014–September 2016 were retrospectively reviewed. ENoG was performed 10–16 days after symptom onset. Patients were classified into Groups A (ENoG value 10%–20%, n?=?9) and B (ENoG value <10%, n?=?21). Eight months after symptom onset, electrophysiological and symptomatic outcomes were evaluated as the aberrant regeneration ratio of the blink reflex and the total synkinesis score of the Sunnybrook facial grading system, respectively. The outcomes of the groups were compared.

Results: Group B had a significantly higher median aberrant regeneration ratio (0% versus 87%, p=.015), median total synkinesis score (1 versus 3, p?<?.001), and incidence of moderate-to-severe synkinesis (0% versus 57.2%, p=.003) than did Group A.

Conclusions and significance: Patients with an ENoG value of <10% have higher risks of aberrant regeneration and moderate-to-severe synkinesis than those with an ENoG value of 10%–20%. Patients with ENoG values of <10% may require rehabilitation to prevent synkinesis.     

The facial nerve canal in patients with Bell’s palsy: an investigation by high-resolution computed tomography with multiplanar reconstruction

Facial nerve edema is an important finding in Bell’s palsy patients. Inflammation may cause facial nerve edema, and mechanical compression and ischemic change of the facial nerve may occur in the facial nerve canal. A few studies have reported the dimensions of the facial nerve canal using conventional computed tomography or human temporal bone sections. However, the cross-sectional area of the facial nerve canal has not been fully understood. Therefore, the cross-sectional area of the facial nerve canal was measured in patients with unilateral Bell’s palsy by computer tomography with multiplanar reconstruction. Sixteen patients with unilateral Bell’s palsy were enrolled. Computed tomography of the temporal bone was performed, and perpendicular images to the facial nerve canal were reconstructed by the multiplanar reconstruction technique. The cross-sectional area of the facial nerve canal on the affected and unaffected sides was measured at the labyrinthine segment, the horizontal segment, and the mastoid segment. Both in the labyrinthine and horizontal segments, the mean cross-sectional area of the facial nerve canal was significantly smaller on the affected side than on the unaffected side. There was no significant difference between the affected and unaffected sides in the cross-sectional area of the facial nerve canal in the mastoid segment. The labyrinthine segment was the narrowest segment in the facial nerve canal. These findings suggest that the facial nerve is vulnerable, especially in the labyrinthine segment of the facial nerve canal, and a narrow facial nerve canal may be one of the risk factors for Bell’s palsy.     

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.     

Cogan’s syndrome: clinical evolution of deafness and vertigo in three patients

The aim of this study was to evaluate the clinical symptoms, the otoneurological examinations, the treatment and the clinical course of three patients suffering from Cogans syndrome, a rare disease based on the clinical association of a non-syphilitic interstitial keratitis with a cochleo-vestibular deficit. This case series involved three patients with follow up. The clinical course of the three patients (aged 30, 48 and 49 years) with Cogans syndrome during a follow-up period of 2 to 6 years is reported. All patients underwent complete otoneurological, ophthalmologic and rheumatologic examinations and were treated with immunosuppressive therapy such as glucocorticoids and cyclophosphamide in two and glucocorticoids and methotrexate in one patient. Using immunosuppressive therapy, ophthalmologic symptoms disappeared rapidly in two patients. Hearing improved only in one and stabilized in a second patient. One patient died after 6 years of treatment because of complications of generalized vasculitis. Early diagnosis and rapid initiation of a combined immunosuppressive therapy such as corticosteroids and cyclophosphamide seem to be important in controlling the disease and avoiding persistent deafness. Whether systemic complications and a fatal outcome also can be prevented is still questionable.This paper was presented at the 35th Congress of the International Society of Otoneurology, Paris, France, 25 May 2001.     

Medical management of Ménière’s disease: a 10-year case series and review of literature

Ménière’s disease is frequent in our area. It is a disabling pathology that affects the patient’s quality of life. Its etiology and pathophysiology remain unclear and there are some therapeutic alternatives with controversial results. We present our series and treatment protocol for Ménière’s disease and discuss the current evidence regarding its medical treatment. In the last 10 years, 252 patients were diagnosed with Ménière’s disease based on their symptoms, and the results of tonal audiometry, videonystagmography and caloric stimulation tests. All cases received medical treatment according to our management protocol. Ménière’s disease is more frequent in women (54.76%); 83.73% of cases are unilateral. Among these, vertigo was observed in 93.7%, hearing loss in 88.1%, tinnitus in 86.1% and pathologic caloric stimulation tests in 71% (88.27% with a reduced vestibular response). A 5-year follow-up was performed in 89.6% of the patients. Subjective improvement as reported by patients was achieved in 94.4% of the cases. There is great controversy about the medical treatment of Ménière’s disease. We found no evidence for the most adequate medical treatment among the different alternatives described in literature. The patient’s acceptance and understanding of the disease is very important.     

Tuberculous and non-tuberculous cervical lymphadenopathy incidence and distribution in Somalia from 2016 to 2020: A review of 241 cases

Objective: To determine the incidence of tuberculous lymphadenitis (TBL) and other pathologies in cervical lymphadenopathies in Somalia and accompanying radiological findings.Methods: In this hospital-based retrospective study, the demographic character-istics, pathology results and radiological findings of 263 patients who underwent ultrasound (US)-guided cervical lymph node biopsy between January 2016 and February 2020 were analyzed.Results: Of 241 patients 118 men and 123 women (mean age 27.9...