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Liu SW, Wright DT, Abramczyk E, Hadford SP, Genther DJ, Byrne PJ, Fritz MA, Ciolek PJ. Management, Referral Patterns, and Outcomes in Bell's Palsy: A Single-Institution 903 Patient Series. Otolaryngol Head Neck Surg 2023; 169:858-864. [PMID: 36946693 DOI: 10.1002/ohn.313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE In 2013, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published guidelines for Bell's palsy (BP), including recommendations for workup, management, and specialist referral. Patients with BP often present to primary care; however, adherence to guidelines may vary by setting. This study sought to evaluate the management of patients with BP presenting to primary care, emergency department (ED), and urgent care settings. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care center. METHODS Retrospective chart review of patients identified by diagnosis code for BP. RESULTS A total of 903 patients were included; 687 (76.1%) presented to ED, 87 (9.6%) to internal medicine, 77 (8.5%) to family medicine, and 52 (5.8%) to urgent care. On presentation, 804 (89.0%) patients were prescribed corticosteroids and 592 (65.6%) antiviral therapy. Steroid therapy ranged from 1 dose to greater than a 14-day course, with 177 (19.6%) receiving an adequate duration of 10 days or greater. Referrals were provided to facial plastics and/or otolaryngology for 51 patients (5.6%). For all comers, 283 (31.3%) had complete resolution, 197 (21.8%) had an incomplete resolution, 62 (6.9%) had persistent palsy, and 361 (40.0%) lost to follow-up. In assessing the association between clinic setting and management, appropriate corticosteroid therapy (p < .01), imaging (p < .01), and eye care (p < .01) were statistically significant. CONCLUSION Adherence to guidelines for BP management varies amongst providers. In our study cohort, 15.5% of patients received medical therapy in accordance with AAO-HNS guidelines, and only 5.6% were referred to facial plastics. To facilitate more appropriate care, tertiary care institutions may benefit from system-wide care pathways to manage acute BP.
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Affiliation(s)
- Sara W Liu
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Darrell T Wright
- Department of Head and Neck Surgery, Mid-Atlante Permanente Medical Group, Woodbridge, Virginia, USA
| | - Emily Abramczyk
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Stephen P Hadford
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Dane J Genther
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Patrick J Byrne
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Michael A Fritz
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Peter J Ciolek
- Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
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Jalali MM, Soleimani R, Soltanipour S, Jalali SM. Pharmacological Treatments of Bell's Palsy in Adults: A Systematic Review and Network Meta-Analysis. Laryngoscope 2021; 131:1615-1625. [PMID: 33404068 DOI: 10.1002/lary.29368] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We aimed to simultaneously compare all available medical treatments for Bell's palsy using both direct and indirect data. METHODS The literature was searched from January 1, 1990, until March 1, 2020, with no language restrictions. Randomized clinical trials comparing pharmacological interventions were included in the current network meta-analysis. We estimated summary risk ratios (RRs), 95% credible interval (CrI), and the surface under the cumulative ranking curve (SUCRA) using network meta-analyses with random effects in a Bayesian framework. The primary outcomes were complete recovery in short-term (≤3 months) and intermediate/long-term (>3 months) after randomization. The secondary outcome was synkinesis. RESULTS In total, 21 trials comprising 2,839 participants were retrieved. In terms of good recovery, corticosteroids plus antivirals were the most effective treatment compared to placebo, with RRs ranging between 1.25 (95% CrI: 1.10, 1.43) for the short-term and 1.26 (95% CrI: 1.11, 1.45) for the intermediate/long-term recovery. For synkinesis, only corticosteroids plus antivirals (RR 0.35; 95% CrI: 0.19, 0.65) were associated with fewer synkinesis rates than placebo. The certainty of the evidence for good recovery and synkinesis was very low-low and moderate-high, respectively. CONCLUSIONS This network meta-analysis showed that combined therapy remains the best regimen for a good recovery outcome and the only efficacious regimen for synkinesis. More research is needed to confirm these findings. Laryngoscope, 131:1615-1625, 2021.
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Affiliation(s)
- Mir Mohammad Jalali
- Professor of Otology/Neurotology, Otorhinolaryngology Research Center, Department of Otolaryngology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Robabeh Soleimani
- Associate Professor of Psychiatry, Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Soltanipour
- Associate Professor of Community Medicine, Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Seyede Melika Jalali
- Doctor of Pharmacy, Pharmacy Faculty, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran
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Lavinsky J, Kosugi EM, Baptistella E, Roithmann R, Dolci E, Ribeiro TK, Rossini B, Romano FR, Maunsell RCK, Mitre EI, Imamura R, Hachiya A, Chone CT, Watanabe LMN, Fornazieri MA, Lessa MM, Sant'Anna GD. An update on COVID-19 for the otorhinolaryngologist - a Brazilian Association of Otolaryngology and Cervicofacial Surgery (ABORL-CCF) Position Statement. Braz J Otorhinolaryngol 2020; 86:273-280. [PMID: 32371055 PMCID: PMC7151294 DOI: 10.1016/j.bjorl.2020.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction We are facing a pandemic with a great impact worldwide, as a result of the rapid spread of the novel coronavirus (COVID-19). The medical community is still getting to know behavior of this virus and the consequences from a population point of view. All this knowledge is extremely dynamic, so some behaviors are still not well established. Otorhinolaryngologists have a central role in the management of this situation, in which they must assess the patient, avoid contamination to and by health professionals and other patients. Thus, the recommendations of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery (ABORL-CCF) have the main objective of reducing the spread of the new coronavirus during otorhinolaryngological care and assisting in the management of these patients. Methods Review of the main recommendations of national and international scientific societies, decisions by government agencies and class councils. The topics will be related to the general aspects of COVID-19, personal protective equipment, care in patient assistance, endoscopic exam routines and the management of sinonasal, otological and pediatric evaluations related to COVID-19. Results The use of personal protective equipment is considered crucial in routine ENT care. We recommend postponing appointments, exams and elective surgeries to reduce the spread of COVID-19. Similarly, we recommend changing routines in several areas of otolaryngology. Additionally, guidance is provided on the use of telemedicine resources during the pandemic period. Conclusions We are still at the beginning of the COVID-19 pandemic and scientific evidence is still scarce and incomplete, so these ABORL-CCF recommendations for otorhinolaryngologists may be updated based on new knowledge and the pattern of the new coronavirus spread.
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Affiliation(s)
- Joel Lavinsky
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Eduardo Macoto Kosugi
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Eduardo Baptistella
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Renato Roithmann
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Eduardo Dolci
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Thais Knoll Ribeiro
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Bruno Rossini
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Fabrizio Ricci Romano
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | | | - Edson Ibrahim Mitre
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Rui Imamura
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Adriana Hachiya
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Carlos Takahiro Chone
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Luciana Miwa Nita Watanabe
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Marco Aurélio Fornazieri
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Marcus Miranda Lessa
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil
| | - Geraldo Druck Sant'Anna
- Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF), São Paulo, SP, Brazil.
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Abstract
BACKGROUND Bell's palsy is a peripheral paralysis of the seventh cranial nerve, whose etiology is unknown. Using polymerase chain reaction technology, it is possible to sample accessible body fluids and identify possible viral factors. The purpose of this research is to investigate its connection to the herpes virus family by testing for the presence of the virus in the saliva and tear fluid of Bell's palsy patients. METHODS Saliva and tears were collected from 42 children and adolescents suffering from idiopathic facial nerve paralysis. Polymerase chain reaction was used to test for the presence of the viruses Epstein-Barr virus, cytomegalovirus, herpes simplex virus 1 and 2, varicella zoster virus and human herpes virus 6 (HHV-6). Samples were also taken from a control group without paralysis. A second specimen was taken from patients who tested positive for HHV-6 several months after their recovery. RESULTS Of the 42 patients in the study group, 71% (30 patients) tested positive for HHV-6, compared with only 37% of the control group (P = 0.001). The prevalence of the other 5 viruses tested was low-herpes simplex virus 1: 9.5%, Epstein-Barr virus: 9.5%, cytomegalovirus: 4.8%, varicella zoster virus: 2.3% and herpes simplex virus 2: 0%. Twenty-four of the 30 patients who were HHV-6-positive during their illness were reexamined following recovery. Only 13 patients (54.2%) excreted the virus after recovery from the paralysis. CONCLUSIONS Herpes 6 virus appears to play some role in the etiology of facial nerve paralysis. The virus was detected in the saliva of children during acute illness and decreased with resolution. Our research opens new insights linking HHV-6 to the etiology of Bell's palsy in children.
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Tuna Edizer D, Dönmez Z, Gül M, Yiğit Ö, Yiğitcan B, Adatepe T, Uzun N. Effects of Melatonin and Dexamethasone on Facial Nerve Neurorrhaphy. J Int Adv Otol 2018; 15:43-50. [PMID: 30541731 DOI: 10.5152/iao.2018.3273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate the effects of topical and systemic administrations of melatonin and dexamethasone on facial nerve regeneration. MATERIALS AND METHODS In total, 50 male albino Wistar rats underwent facial nerve axotomy and neurorrhaphy. The animals were divided into 5 groups: control, topical melatonin, systemic melatonin, topical dexamethasone, and systemic dexamethasone. Nerve conduction studies were performed preoperatively and at 3, 6, 9, and 12 weeks after drug administrations. Amplitude and latency of the compound muscle action potentials were recorded. Coapted facial nerves were investigated under light and electron microscopy. Nerve diameter, axon diameter, and myelin thickness were recorded quantitatively. RESULTS Amplitudes decreased and latencies increased in both the melatonin and dexamethasone groups. At the final examination, the electrophysiological evidence of facial nerve degeneration was not significantly different between the groups. Histopathological examinations revealed the largest nerve diameter in the melatonin groups, followed by the dexamethasone and control groups (p<0.05). Axon diameter of the control group was smaller than those of the melatonin (topical and systemic) and topical dexamethasone groups (p<0.05). The melatonin groups had almost normal myelin ultrastructure. CONCLUSION Electrophysiological evaluation did not reveal any potential benefit of dexamethasone and melatonin in contrast to histopathological examination, which revealed beneficial effects of melatonin in particular. These agents may increase the regeneration of facial nerves, but electrophysiological evidence of regeneration may appear later.
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Affiliation(s)
- Deniz Tuna Edizer
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Zehra Dönmez
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Gül
- Department of Histology and Embryology, İnönü University School of Medicine, Malatya, Turkey
| | - Özgür Yiğit
- Department of Otorhinolaryngology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Birgül Yiğitcan
- Department of Histology and Embryology, İnönü University School of Medicine, Malatya, Turkey
| | - Turgut Adatepe
- Department of Electrophysiology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Nurten Uzun
- Department of Neurology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
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Raftery J, Hanney S, Greenhalgh T, Glover M, Blatch-Jones A. Models and applications for measuring the impact of health research: update of a systematic review for the Health Technology Assessment programme. Health Technol Assess 2018; 20:1-254. [PMID: 27767013 DOI: 10.3310/hta20760] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This report reviews approaches and tools for measuring the impact of research programmes, building on, and extending, a 2007 review. OBJECTIVES (1) To identify the range of theoretical models and empirical approaches for measuring the impact of health research programmes; (2) to develop a taxonomy of models and approaches; (3) to summarise the evidence on the application and use of these models; and (4) to evaluate the different options for the Health Technology Assessment (HTA) programme. DATA SOURCES We searched databases including Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and The Cochrane Library from January 2005 to August 2014. REVIEW METHODS This narrative systematic literature review comprised an update, extension and analysis/discussion. We systematically searched eight databases, supplemented by personal knowledge, in August 2014 through to March 2015. RESULTS The literature on impact assessment has much expanded. The Payback Framework, with adaptations, remains the most widely used approach. It draws on different philosophical traditions, enhancing an underlying logic model with an interpretative case study element and attention to context. Besides the logic model, other ideal type approaches included constructionist, realist, critical and performative. Most models in practice drew pragmatically on elements of several ideal types. Monetisation of impact, an increasingly popular approach, shows a high return from research but relies heavily on assumptions about the extent to which health gains depend on research. Despite usually requiring systematic reviews before funding trials, the HTA programme does not routinely examine the impact of those trials on subsequent systematic reviews. The York/Patient-Centered Outcomes Research Institute and the Grading of Recommendations Assessment, Development and Evaluation toolkits provide ways of assessing such impact, but need to be evaluated. The literature, as reviewed here, provides very few instances of a randomised trial playing a major role in stopping the use of a new technology. The few trials funded by the HTA programme that may have played such a role were outliers. DISCUSSION The findings of this review support the continued use of the Payback Framework by the HTA programme. Changes in the structure of the NHS, the development of NHS England and changes in the National Institute for Health and Care Excellence's remit pose new challenges for identifying and meeting current and future research needs. Future assessments of the impact of the HTA programme will have to take account of wider changes, especially as the Research Excellence Framework (REF), which assesses the quality of universities' research, seems likely to continue to rely on case studies to measure impact. The HTA programme should consider how the format and selection of case studies might be improved to aid more systematic assessment. The selection of case studies, such as in the REF, but also more generally, tends to be biased towards high-impact rather than low-impact stories. Experience for other industries indicate that much can be learnt from the latter. The adoption of researchfish® (researchfish Ltd, Cambridge, UK) by most major UK research funders has implications for future assessments of impact. Although the routine capture of indexed research publications has merit, the degree to which researchfish will succeed in collecting other, non-indexed outputs and activities remains to be established. LIMITATIONS There were limitations in how far we could address challenges that faced us as we extended the focus beyond that of the 2007 review, and well beyond a narrow focus just on the HTA programme. CONCLUSIONS Research funders can benefit from continuing to monitor and evaluate the impacts of the studies they fund. They should also review the contribution of case studies and expand work on linking trials to meta-analyses and to guidelines. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- James Raftery
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Steve Hanney
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Glover
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Amanda Blatch-Jones
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
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Karatzanis A, Chatzidakis A, Milioni A, Vlaminck S, Kawauchi H, Velegrakis S, Prokopakis E. Contemporary Use of Corticosteroids in Rhinology. Curr Allergy Asthma Rep 2017; 17:11. [PMID: 28233155 DOI: 10.1007/s11882-017-0679-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW Exogenously administered corticosteroids are widely used today in the field of rhinology. Allergic rhinitis (AR), non-allergic rhinitis (NAR), acute rhinosinusitis (ARS), chronic rhinosinusitis with (CRSwNP) and without (CRSsNP) nasal polyps, and autoimmune disorders with nasal manifestations are common diseases treated effectively with intranasal and oral glucocorticoids. We focus on physiological pathways, therapeutic benefits, indications, contra-indications, and side effects of glucocorticoid utilization in the treatment of rhinologic disorders such as AR, NAR, ARS, CRSsNP, and CRSwNP. RECENT FINDINGS Second-generation intranasal steroid (INS) agents have pharmacokinetic characteristics that minimize their systemic bioavailability, resulting in minimum risk for systemic adverse events. Several studies have demonstrated the symptomatic efficacy of both intranasal and oral corticosteroids in ARS. Moreover, intranasal and systemic steroid administration has been repeatedly proven beneficial in the conservative and perioperative management of CRSwNP. For patients with AR, there is no need for oral steroids, with the exception of severe cases, as there is lack of superiority to INS. SCUAD patients challenge currently available treatment schemes, underlining the importance of research in the field. Corticosteroids' effectiveness in the treatment of various rhinologic disorders is indisputable. However, their characteristics, and potential side effects, make a clear consensus for utilization difficult.
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Affiliation(s)
- Alexander Karatzanis
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Alkiviadis Chatzidakis
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Athanasia Milioni
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Stephan Vlaminck
- Department of Otorhinolaryngology, St. Jan General Hospital, Bruges, Belgium
| | - Hideyuki Kawauchi
- Department of Otorhinolaryngology, School of Medicine, University of Shimane, Shimane, Japan
| | - Stylianos Velegrakis
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, School of Medicine, University of Crete, Heraklion, Crete, Greece. .,Department of Otorhinolaryngology, University Hospital of Crete, University avenue, A Building 3rd Floor, 71110, Heraklion, Crete, Greece.
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8
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Affiliation(s)
| | - Frank Sullivan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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9
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Rivera A, Raymond M, Grobman A, Abouyared M, Angeli SI. The effect of n-acetyl-cysteine on recovery of the facial nerve after crush injury. Laryngoscope Investig Otolaryngol 2017; 2:109-112. [PMID: 28894829 PMCID: PMC5527362 DOI: 10.1002/lio2.68] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/31/2016] [Accepted: 01/05/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Facial nerve dysfunction can vary in severity and recovery is dependent on the character of the injury. N-acetyl-cysteine prevents oxidative stress and cellular damage, and its use in the setting of nerve dysfunction from crush injury has not yet been established. In this study, rats with facial nerve crush injury will be treated with n-acetyl-cysteine or control and functional recovery and electrophysiologic outcome will be compared. STUDY DESIGN Prospective, randomized animal study. METHODS Twenty-four Wistar rats underwent unilateral facial nerve crush injury. Rats were implanted with a subcutaneous osmotic pump filled with saline (n = 12) or n-acetyl-cysteine 50 mg/kg/day (n = 12). Functional and electromyographic recovery was recorded at two and four weeks postoperatively. RESULTS When compared to untreated rats, n-acetyl-cysteine treated rats had a greater electromyography amplitude recovery at 2 weeks with regard to eye blink (p=0.006) but not vibrissae function. At four weeks, the electromyography amplitude recovery of the vibrissae function was greater in n-acetyl-cysteine treated rats (P=0.001), but the amplitude recovery difference in eye blink was only marginally significant between groups (p=0.07). The functional score was higher in n-acetyl-cysteine-treated rats than in untreated rats at all of the time points. CONCLUSION This study demonstrated that n-acetyl-cysteine facilitated facial nerve recovery with improved functional and electromyography outcomes in the setting of crush injury. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Andrew Rivera
- Department of OtolaryngologyUniversity of MiamiMiamiFlorida
| | - Mallory Raymond
- Department of OtolaryngologyEmory UniversityAtlantaGeorgiaU.S.A
| | - Ariel Grobman
- Department of OtolaryngologyUniversity of MiamiMiamiFlorida
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10
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Babl FE, Gardiner KK, Kochar A, Wilson CL, George SA, Zhang M, Furyk J, Thosar D, Cheek JA, Krieser D, Rao AS, Borland ML, Cheng N, Phillips NT, Sinn KK, Neutze JM, Dalziel SR. Bell's palsy in children: Current treatment patterns in Australia and New Zealand. A PREDICT study. J Paediatr Child Health 2017; 53:339-342. [PMID: 28177168 DOI: 10.1111/jpc.13463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/29/2016] [Accepted: 11/18/2016] [Indexed: 12/19/2022]
Abstract
AIM The aetiology and clinical course of Bell's palsy may be different in paediatric and adult patients. There is no randomised placebo controlled trial (RCT) to show effectiveness of prednisolone for Bell's palsy in children. The aim of the study was to assess current practice in paediatric Bell's palsy in Australia and New Zealand Emergency Departments (ED) and determine the feasibility of conducting a multicentre RCT within the Paediatric Research in Emergency Departments International Collaborative (PREDICT). METHODS A retrospective analysis of ED medical records of children less than 18 years diagnosed with Bell's palsy between 1 January, 2012 and 31 December, 2013 was performed. Potential participants were identified from ED information systems using Bell's palsy related search terms. Repeat presentations during the same illness were excluded but relapses were not. Data on presentation, diagnosis and management were entered into an online data base (REDCap). RESULTS Three hundred and twenty-three presentations were included from 14 PREDICT sites. Mean age at presentation was 9.0 (SD 5.0) years with 184 (57.0%) females. Most (238, 73.7%) presented to ED within 72 h of symptoms, 168 (52.0%) had seen a doctor prior. In ED, 218 (67.5%) were treated with steroids. Prednisolone was usually prescribed for 9 days at around 1 mg/kg/day, with tapering in 35.7%. CONCLUSION Treatment of Bell's palsy in children presenting to Australasian EDs is varied. Prednisolone is commonly used in Australasian EDs, despite lack of high-level paediatric evidence. The study findings confirm the feasibility of an RCT of prednisolone for Bell's palsy in children.
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Affiliation(s)
- Franz E Babl
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kaya K Gardiner
- Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Amit Kochar
- Emergency Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Catherine L Wilson
- Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Shane A George
- Emergency Department, Gold Coast University Hospital, School of Medicine, Griffith University, Gold Coast, Townsville, Queensland, Australia
| | - Michael Zhang
- Emergency Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jeremy Furyk
- Emergency Department, Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Queensland, Australia
| | - Deepali Thosar
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - John A Cheek
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Clinical Sciences Theme, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - David Krieser
- Emergency Department, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Arjun S Rao
- Emergency Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Meredith L Borland
- Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia, Australia
| | - Nicholas Cheng
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Natalie T Phillips
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Kam K Sinn
- Emergency Department, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Jocelyn M Neutze
- Emergency Department, KidzFirst Middlemore Hospital, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Stuart R Dalziel
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Emergency Department, Starship Children's Hospital, Auckland, New Zealand
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Babl FE, Mackay MT, Borland ML, Herd DW, Kochar A, Hort J, Rao A, Cheek JA, Furyk J, Barrow L, George S, Zhang M, Gardiner K, Lee KJ, Davidson A, Berkowitz R, Sullivan F, Porrello E, Dalziel KM, Anderson V, Oakley E, Hopper S, Williams F, Wilson C, Williams A, Dalziel SR. Bell's Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial. BMC Pediatr 2017; 17:53. [PMID: 28193257 PMCID: PMC5307816 DOI: 10.1186/s12887-016-0702-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bell's palsy or acute idiopathic lower motor neurone facial paralysis is characterized by sudden onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. While there is high level evidence in adults demonstrating an improvement in the rate of complete recovery of facial nerve function when treated with steroids compared with placebo, similar high level studies on the use of steroids in Bell's palsy in children are not available. The aim of this study is to assess the utility of steroids in Bell's palsy in children in a randomised placebo-controlled trial. METHODS/DESIGN We are conducting a randomised, triple-blinded, placebo controlled trial of the use of prednisolone to improve recovery from Bell's palsy at 1 month. Study sites are 10 hospitals within the Australian and New Zealand PREDICT (Paediatric Research in Emergency Departments International Collaborative) research network. 540 participants will be enrolled. To be eligible patients need to be aged 6 months to < 18 years and present within 72 hours of onset of clinician diagnosed Bell's palsy to one of the participating hospital emergency departments. Patients will be excluded in case of current use of or contraindications to steroids or if there is an alternative diagnosis. Participants will receive either prednisolone 1 mg/kg/day to a maximum of 50 mg/day or taste matched placebo for 10 days. The primary outcome is complete recovery by House-Brackmann scale at 1 month. Secondary outcomes include assessment of recovery using the Sunnybrook scale, the emotional and functional wellbeing of the participants using the Pediatric Quality of Life Inventory and Child Health Utility 9D Scale, pain using Faces Pain Scale Revised or visual analogue scales, synkinesis using a synkinesis assessment questionnaire and health utilisation costs at 1, 3 and 6 months. Participants will be tracked to 12 months if not recovered earlier. Data analysis will be by intention to treat with primary outcome presented as differences in proportions and an odds ratio adjusted for site and age. DISCUSSION This large multicenter randomised trial will allow the definitive assessment of the efficacy of prednisolone compared with placebo in the treatment of Bell's palsy in children. TRIAL REGISTRATION The study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12615000563561 (1 June 2015).
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Affiliation(s)
- Franz E. Babl
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Mark T. Mackay
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Neurology, Royal Children’s Hospital, Parkville, VIC Australia
| | - Meredith L. Borland
- Princess Margaret Hospital for Children, Perth, Australia
- Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia Australia
| | - David W. Herd
- Lady Cilento Children’s Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
| | - Amit Kochar
- Women’s & Children’s Hospital, Adelaide, Australia
| | - Jason Hort
- The Children’s Hospital at Westmead, Sydney, Australia
| | - Arjun Rao
- Sydney Children’s Hospital, Randwick, New South Wales, Australia
| | - John A. Cheek
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Monash Medical Centre, Clayton, Victoria, Australia
| | - Jeremy Furyk
- Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Australia
| | - Lisa Barrow
- Sunshine Hospital, St Albans, Victoria Australia
| | - Shane George
- Gold Coast University Hospital, Southport, Queensland Australia
| | - Michael Zhang
- John Hunter Hospital, Newcastle, New South Wales Australia
| | - Kaya Gardiner
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Katherine J. Lee
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Andrew Davidson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Anaesthesia, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Robert Berkowitz
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Otolaryngology, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Frank Sullivan
- Department of Family & Community Medicine, North York General Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Emily Porrello
- Pharmacy Department, Royal Children’s Hospital, Parkville, Victoria Australia
| | - Kim Marie Dalziel
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Centre for Health Policy Melbourne School of Global and Population Health, The University of Melbourne, Carlton, Victoria Australia
| | - Vicki Anderson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Psychological Sciences & Paediatrics, University of Melbourne, The Royal Children’s Hospital, Melbourne, VIC Australia
| | - Ed Oakley
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Sandy Hopper
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
| | - Fiona Williams
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Catherine Wilson
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Amanda Williams
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
| | - Stuart R Dalziel
- Starship Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - for the PREDICT (Paediatric Research In Emergency Departments International Collaborative) research network
- Department of Emergency Medicine, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052 Australia
- Murdoch Children’s Research Institute, Parkville, Victoria Australia
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC Australia
- Department of Neurology, Royal Children’s Hospital, Parkville, VIC Australia
- Princess Margaret Hospital for Children, Perth, Australia
- Schools of Paediatric and Child Health and Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Western Australia Australia
- Lady Cilento Children’s Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
- Women’s & Children’s Hospital, Adelaide, Australia
- The Children’s Hospital at Westmead, Sydney, Australia
- Sydney Children’s Hospital, Randwick, New South Wales, Australia
- Monash Medical Centre, Clayton, Victoria, Australia
- Townsville Hospital and James Cook University College of Medicine and Dentistry, Townsville, Australia
- Sunshine Hospital, St Albans, Victoria Australia
- Gold Coast University Hospital, Southport, Queensland Australia
- John Hunter Hospital, Newcastle, New South Wales Australia
- Department of Anaesthesia, Royal Children’s Hospital, Parkville, Victoria Australia
- Department of Otolaryngology, Royal Children’s Hospital, Parkville, Victoria Australia
- Department of Family & Community Medicine, North York General Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Pharmacy Department, Royal Children’s Hospital, Parkville, Victoria Australia
- Centre for Health Policy Melbourne School of Global and Population Health, The University of Melbourne, Carlton, Victoria Australia
- Psychological Sciences & Paediatrics, University of Melbourne, The Royal Children’s Hospital, Melbourne, VIC Australia
- Starship Hospital, Auckland, New Zealand
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Kilicaslan S, Uluyol S, Gur MH, Arslan IB, Yagiz O. Diagnostic and prognostic value of procalcitonin levels in patients with Bell's palsy. Eur Arch Otorhinolaryngol 2016; 273:1615-8. [PMID: 26894418 DOI: 10.1007/s00405-016-3937-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/11/2016] [Indexed: 01/03/2023]
Abstract
Inflammation is thought to play an important role in the pathogenesis of Bell's palsy (BP). Procalcitonin (PCT) is currently among the most frequently used proinflammatory biomarkers in clinical practice. In this study, we assessed the serum PCT levels for predicting the severity and prognosis of BP. In total, 32 patients with House-Brackmann (HB) grade II and III BP (low-grade group), 22 patients with HB grade IV and V (high-grade group) and 35 healthy individuals (control group) were included in this prospective study. PCT levels were compared among these three groups at the time of diagnosis. All patients received standard prednisolone and acyclovir treatment. The correlation between PCT levels and recovery was analyzed 3 months after treatment. The PCT levels for control, low-grade and high-grade BP groups were 0.01 ± 0.001, 0.35 ± 0.05, and 0.98 ± 0.41 ng/mL, respectively. The PCT level in low-grade group was significantly higher than that in control group (p < 0.001), and the PCT level in high-grade BP group was significantly higher than that in low-grade group (p = 0.01, p < 0.05). The complete recovery rate was 93.7 % in low-grade and 54.5 % in high-grade BP group (p = 0.015, p < 0.05). There was a strong negative correlation between PCT levels and recovery rates (r = -0.896, p < 0.001). PCT levels were significantly associated with the severity of BP and higher PCT levels were related with poor clinical outcome in terms of recovery. These results support the diagnostic and prognostic significance of PCT in patients with early BP.
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Affiliation(s)
- Saffet Kilicaslan
- Department of Otolaryngology, Van Training and Research Hospital, Van, Turkey.
| | - Sinan Uluyol
- Department of Otolaryngology, Van Training and Research Hospital, Van, Turkey
| | - Mehmet Hafit Gur
- Department of Otolaryngology, Van Training and Research Hospital, Van, Turkey
| | - Ilker Burak Arslan
- Department of Otolaryngology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ozlem Yagiz
- Department of Otolaryngology, Tepecik Training and Research Hospital, Izmir, Turkey
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Liu ZD, He JB, Guo SS, Yang ZX, Shen J, Li XY, Liang W, Shen WD. Effects of electroacupuncture therapy for Bell's palsy from acute stage: study protocol for a randomized controlled trial. Trials 2015; 16:378. [PMID: 26303741 PMCID: PMC4548841 DOI: 10.1186/s13063-015-0893-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/31/2015] [Indexed: 11/10/2022] Open
Abstract
Background Although many patients with facial paralysis have obtained benefits or completely recovered after acupuncture or electroacupuncture therapy, it is still difficult to list intuitive evidence besides evaluation using neurological function scales and a few electrophysiologic data. Hence, the aim of this study is to use more intuitive and reliable detection techniques such as facial nerve magnetic resonance imaging (MRI), nerve electromyography, and F waves to observe changes in the anatomic morphology of facial nerves and nerve conduction before and after applying acupuncture or electroacupuncture, and to verify their effectiveness by combining neurological function scales. Methods/Design A total of 132 patients with Bell’s palsy (grades III and IV in the House-Brackmann [HB] Facial Nerve Grading System) will be randomly divided into electroacupuncture, manual acupuncture, non-acupuncture, and medicine control groups. All the patients will be given electroacupuncture treatment after the acute period, except for patients in the medicine control group. The acupuncture or electroacupuncture treatments will be performed every 2 days until the patients recover or withdraw from the study. The primary outcome is analysis based on facial nerve functional scales (HB scale and Sunnybrook facial grading system), and the secondary outcome is analysis based on MRI, nerve electromyography and F-wave detection. All the patients will undergo MRI within 3 days after Bell’s palsy onset for observation of the signal intensity and facial nerve swelling of the unaffected and affected sides. They will also undergo facial nerve electromyography and F-wave detection within 1 week after onset of Bell’s palsy. Nerve function will be evaluated using the HB scale and Sunnybrook facial grading system at each hospital visit for treatment until the end of the study. The MRI, nerve electromyography, and F-wave detection will be performed again at 1 month after the onset of Bell’s palsy. Trial registration Chinese Clinical Trials Register identifier: ChiCTR-IPR-14005730. Registered on 23 December 2014.
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Affiliation(s)
- Zhi-dan Liu
- Department of Acupuncture, Baoshan Hospital of Integrated TCM and Western Medicine, Shanghai, 201999, China. .,Department of Acupuncture, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Jiang-bo He
- Department of Medical Imaging, Baoshan Hospital of Integrated TCM and Western Medicine, Shanghai, China.
| | - Si-si Guo
- Department of Neurology, Baoshan Hospital of Integrated TCM and Western Medicine, Shanghai, 201999, China.
| | - Zhi-xin Yang
- Department of Gerontology, Baoshan Hospital of Integrated TCM and Western Medicine, Shanghai, 201999, China.
| | - Jun Shen
- Department of Neurology, Third People's Hospital, Shanghai Jiaotong University, Shanghai, 201999, China.
| | - Xiao-yan Li
- Department of Acupuncture, Baoshan Hospital of Integrated TCM and Western Medicine, Shanghai, 201999, China.
| | - Wei Liang
- Department of Acupuncture, Baoshan Hospital of Integrated TCM and Western Medicine, Shanghai, 201999, China.
| | - Wei-dong Shen
- Department of Acupuncture, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Turgeon RD, Wilby KJ, Ensom MHH. Antiviral treatment of Bell's palsy based on baseline severity: a systematic review and meta-analysis. Am J Med 2015; 128:617-28. [PMID: 25554380 DOI: 10.1016/j.amjmed.2014.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 11/22/2014] [Accepted: 11/24/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE We conducted a systematic review with meta-analysis to evaluate the efficacy of antiviral agents on complete recovery of Bell's palsy. METHODS We searched CENTRAL, Embase, MEDLINE, International Pharmaceutical Abstracts, and sources of unpublished literature to November 1, 2014. Primary and secondary outcomes were complete and satisfactory recovery, respectively. To evaluate statistical heterogeneity, we performed subgroup analysis of baseline severity of Bell's palsy and between-study sensitivity analyses based on risk of allocation and detection bias. RESULTS The 10 included randomized controlled trials (2419 patients; 807 with severe Bell's palsy at onset) had variable risk of bias, with 9 trials having a high risk of bias in at least 1 domain. Complete recovery was not statistically significantly greater with antiviral use versus no antiviral use in the random-effects meta-analysis of 6 trials (relative risk, 1.06; 95% confidence interval, 0.97-1.16; I(2) = 65%). Conversely, random-effects meta-analysis of 9 trials showed a statistically significant difference in satisfactory recovery (relative risk, 1.10; 95% confidence interval, 1.02-1.18; I(2) = 63%). Response to antiviral agents did not differ visually or statistically between patients with severe symptoms at baseline and those with milder disease (test for interaction, P = .11). Sensitivity analyses did not show a clear effect of bias on outcomes. CONCLUSIONS Antiviral agents are not efficacious in increasing the proportion of patients with Bell's palsy who achieved complete recovery, regardless of baseline symptom severity.
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Affiliation(s)
- Ricky D Turgeon
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada.
| | - Kyle J Wilby
- Qatar University, College of Pharmacy, Doha, Qatar
| | - Mary H H Ensom
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
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15
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The Effect of Methylprednisolone on Facial Nerve Paralysis With Different Etiologies. J Craniofac Surg 2015; 26:810-5. [DOI: 10.1097/scs.0000000000001502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Turriziani O, Falasca F, Maida P, Gaeta A, De Vito C, Mancini P, De Seta D, Covelli E, Attanasio G, Antonelli G. Early collection of saliva specimens from Bell's palsy patients: Quantitative analysis of HHV-6, HSV-1, and VZV. J Med Virol 2014; 86:1752-8. [DOI: 10.1002/jmv.23917] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | - Francesca Falasca
- Department of Molecular Medicine; Sapienza University of Rome; Rome Italy
| | - Paola Maida
- Department of Molecular Medicine; Sapienza University of Rome; Rome Italy
| | - Aurelia Gaeta
- Department of Public Health and Infectious Diseases; Sapienza University of Rome; Rome Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases; Sapienza University of Rome; Rome Italy
| | - Patrizia Mancini
- Department of Sense Organs; Sapienza University of Rome; Rome Italy
| | - Daniele De Seta
- Department of Sense Organs; Sapienza University of Rome; Rome Italy
| | - Edoardo Covelli
- Department of Sense Organs; Sapienza University of Rome; Rome Italy
| | | | - Guido Antonelli
- Department of Molecular Medicine; Sapienza University of Rome; Rome Italy
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Macleod MR, Michie S, Roberts I, Dirnagl U, Chalmers I, Ioannidis JPA, Al-Shahi Salman R, Chan AW, Glasziou P. Biomedical research: increasing value, reducing waste. Lancet 2014; 383:101-4. [PMID: 24411643 DOI: 10.1016/s0140-6736(13)62329-6] [Citation(s) in RCA: 582] [Impact Index Per Article: 58.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Malcolm R Macleod
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK; Department of Neurology, NHS Forth Valley, Larbert, UK.
| | - Susan Michie
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Ian Roberts
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ulrich Dirnagl
- Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA; Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, CA, USA; Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| | - Rustam Al-Shahi Salman
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Robina, Gold Coast, QLD, Australia
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Lee CD, Carnahan RM, McPheeters ML. A systematic review of validated methods for identifying Bell's palsy using administrative or claims data. Vaccine 2013; 31 Suppl 10:K7-11. [PMID: 24331076 DOI: 10.1016/j.vaccine.2013.04.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify and assess billing, procedural, or diagnosis code, or pharmacy claims-based algorithms used to identify Bell's palsy in administrative and claims databases. METHODS We searched the MEDLINE database via PubMed from 1991 to September 2012 using controlled vocabulary and key terms related to Bell's palsy. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria. Two reviewers independently extracted data regarding participant and algorithm characteristics and assessed a study's methodologic rigor. RESULTS One study identified Bell's palsy using an algorithm that included ICD-9 code 351.x and H-ICDA code 350.x, and two other studies analyzed a dataset for ICD-9 code 351.0. The positive predictive values of these studies were 0.81 and 0.88, based on case adjudication of ICD-9 matches. Two further studies calculated incidence rates without validation of their methods, also including ICD-9 code 351.0. No study reported the sensitivity of algorithms to identify Bell's palsy. CONCLUSIONS Few publications used rigorous methods to identify a validated algorithm that could identify cases of Bell's palsy from an administrative database. The best evidence from two different datasets in the literature addressed in this review used ICD-9 code 351.0 or a collection of ICD-9 codes 351.x for facial nerve disorders including Bell's palsy, along with other ICD-9 and H-ICDA codes for facial weakness. Each study had acceptable PPV, suggesting that ICD-9 based-algorithms have some utility in detecting Bell's palsy cases.
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Affiliation(s)
| | - Ryan M Carnahan
- Department of Epidemiology, University of Iowa College of Public Health, S437 CPHB University of Iowa, 105 River Street, Iowa City, IA 52242, USA.
| | - Melissa L McPheeters
- Vanderbilt Evidence-based Practice Center; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738, USA.
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Garg V, Shen X, Cheng Y, Nawarskas JJ, Raisch DW. Use of number needed to treat in cost-effectiveness analyses. Ann Pharmacother 2013; 47:380-7. [PMID: 23463742 DOI: 10.1345/aph.1r417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To review the use of number needed to treat (NNT) and/or number needed to harm (NNH) values to determine their relevance in helping clinicians evaluate cost-effectiveness analyses (CEAs). DATA SOURCES PubMed and EconLit were searched from 1966 to September 2012. STUDY SELECTION AND DATA EXTRACTION Reviews, editorials, non-English-language articles, and articles that did not report NNT/NNH or cost-effectiveness ratios were excluded. CEA studies reporting cost per life-year gained, per quality-adjusted life-year (QALY), or other cost per effectiveness measure were included. Full texts of all included articles were reviewed for study information, including type of journal, impact factor of the journal, focus of study, data source, publication year, how NNT/NNH values were reported, and outcome measures. DATA SYNTHESIS A total of 188 studies were initially identified, with 69 meeting our inclusion criteria. Most were published in clinician-practice-focused journals (78.3%) while 5.8% were in policy-focused journals, and 15.9% in health-economics-focused journals. The majority (72.4%) of the articles were published in high-impact journals (impact factor >3.0). Many articles focused on either disease treatment (40.5%) or disease prevention (40.5%). Forty-eight percent reported NNT as a part of the CEA ratio per event. Most (53.6%) articles used data from literature reviews, while 24.6% used data from randomized clinical trials, and 20.3% used data from observational studies. In addition, 10% of the studies implemented modeling to perform CEA. CONCLUSIONS CEA studies sometimes include NNT ratios. Although it has several limitations, clinicians often use NNT for decision-making, so including NNT information alongside CEA findings may help clinicians better understand and apply CEA results. Further research is needed to assess how NNT/NNH might meaningfully be incorporated into CEA publications.
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Affiliation(s)
- Vishvas Garg
- Pharmacoeconomics, Epidemiology, Pharmaceutical Policy, and Outcomes Research program, Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, University of New Mexico, Albuquerque, NM, USA.
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Seth R, Revenaugh PC, Kaltenbach JA, Rajasekaran K, Meltzer NE, Ghosh D, Alam DS. Facial nerve neurorrhaphy and the effects of glucocorticoids in a rat model. Otolaryngol Head Neck Surg 2012; 147:832-40. [PMID: 22807488 DOI: 10.1177/0194599812451551] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE After nerve injury, an exaggerated neuroinflammatory process may hinder neuron regeneration and recovery. Immunomodulation using glucocorticoids may therefore improve facial nerve injury outcomes. This study aims to examine the effect of both local and systemic dexamethasone administration on facial nerve functional recovery after axotomy in a rat model. STUDY DESIGN Randomized, placebo-controlled, blinded animal study. Setting Animal laboratory. SUBJECTS AND METHODS Seventy-four Wistar rats underwent facial nerve axotomy with immediate neurorrhaphy. Rats were randomly assigned a postoperative group: control (no therapy); systemic dexamethasone 0.5, 1, 5, or 10 mg/kg for 3 administrations; or topically applied dexamethasone at 2 or 4 mg/mL. Blinded, standardized facial assessments and nerve conduction studies (NCS) were performed. Gross facial motion assessments were corroborated with vibrissae frequency video analysis. RESULTS At 8 weeks, rats receiving systemic dexamethasone at 5 mg/kg attained greater eye blink closure (P = .004) and vibrissae motion (P = .012) compared with controls. Systemic dexamethasone at 0.5, 1, and 10 mg/kg and intraoperative topical application of dexamethasone at 2 or 4 mg/mL did not produce a significant improvement in facial motion compared with controls. Nerve conduction studies show a trend of increased return of compound muscle action potential amplitude levels compared with baseline among rats that received systemic dexamethasone 5 mg/kg but do not achieve statistical significance. CONCLUSION In a rat facial nerve axotomy model, high-dose systemic dexamethasone therapy may improve functional recovery when administered in the immediate period following neurorrhaphy.
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Affiliation(s)
- Rahul Seth
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
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Chaparro LE, Wiffen PJ, Moore RA, Gilron I. Combination pharmacotherapy for the treatment of neuropathic pain in adults. Cochrane Database Syst Rev 2012; 2012:CD008943. [PMID: 22786518 PMCID: PMC6481651 DOI: 10.1002/14651858.cd008943.pub2] [Citation(s) in RCA: 152] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pharmacotherapy remains an important modality for the treatment of neuropathic pain. However, as monotherapy current drugs are associated with limited efficacy and dose-related side effects. Combining two or more different drugs may improve analgesic efficacy and, in some situations, reduce overall side effects (e.g. if synergistic interactions allow for dose reductions of combined drugs). OBJECTIVES This review evaluated the efficacy, tolerability and safety of various drug combinations for the treatment of neuropathic pain. SEARCH METHODS We identified randomised controlled trials (RCTs) of various drug combinations for neuropathic pain from CENTRAL, MEDLINE, EMBASE and handsearches of other reviews and trial registries. The most recent search was performed on 9 April 2012. SELECTION CRITERIA Double-blind, randomised studies comparing combinations of two or more drugs (systemic or topical) to placebo and/or at least one other comparator for the treatment of neuropathic pain. DATA COLLECTION AND ANALYSIS Data extracted from each study included: proportion of participants a) reporting ≥ 30% pain reduction from baseline OR ≥ moderate pain relief OR ≥ moderate global improvement; b) dropping out of the trial due to treatment-emergent adverse effects; c) reporting each specific adverse effect (e.g. sedation, dizziness) of ≥ moderate severity. The primary comparison of interest was between study drug(s) and one or both single-agent comparators. We combined studies if they evaluated the same drug class combination at roughly similar doses and durations of treatment. We used RevMan 5 to analyse data for binary outcomes. MAIN RESULTS We identified 21 eligible studies: four (578 participants) evaluated the combination of an opioid with gabapentin or pregabalin; two (77 participants) evaluated an opioid with a tricyclic antidepressant; one (56 participants) of gabapentin and nortriptyline; one (120 participants) of gabapentin and alpha-lipoic acid, three (90 participants) of fluphenazine with a tricyclic antidepressant; three (90 participants) of an N-methyl-D-aspartate (NMDA) blocker with an agent from a different drug class; five (604 participants) of various topical medications; one (313 participants) of tramadol with acetaminophen; and another one (44 participants) of a cholecystokinin blocker (L-365,260) with morphine. The majority of combinations evaluated to date involve drugs, each of which share some element of central nervous system (CNS) depression (e.g. sedation, cognitive dysfunction). This aspect of side effect overlap between the combined agents was often reflected in similar or higher dropout rates for the combination and may thus substantially limit the utility of such drug combinations. Meta-analysis was possible for only one comparison of only one combination, i.e. gabapentin + opioid versus gabapentin alone. This meta-analysis involving 386 participants from two studies demonstrated modest, yet statistically significant, superiority of a gabapentin + opioid combination over gabapentin alone. However, this combination also produced significantly more frequent side effect-related trial dropouts compared to gabapentin alone. AUTHORS' CONCLUSIONS Multiple, good-quality studies demonstrate superior efficacy of two-drug combinations. However, the number of available studies for any one specific combination, as well as other study factors (e.g. limited trial size and duration), preclude the recommendation of any one specific drug combination for neuropathic pain. Demonstration of combination benefits by several studies together with reports of widespread clinical polypharmacy for neuropathic pain surely provide a rationale for additional future rigorous evaluations. In order to properly identify specific drug combinations which provide superior efficacy and/or safety, we recommend that future neuropathic pain studies of two-drug combinations include comparisons with placebo and both single-agent components. Given the apparent adverse impact of combining agents with similar adverse effect profiles (e.g. CNS depression), the anticipated development and availability of non-sedating neuropathic pain agents could lead to the identification of more favourable analgesic drug combinations in which side effects are not compounded.
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Cakarer S, Can T, Cankaya B, Erdem MA, Yazici S, Ayintap E, Özden AV, Keskin C. Peripheral facial nerve paralysis after upper third molar extraction. J Craniofac Surg 2010; 21:1825-7. [PMID: 21119431 DOI: 10.1097/scs.0b013e3181f43dcf] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Peripheral facial nerve paralysis (PFNP) after mandibular interventions has been reported in the literature. In most cases, paralysis begins immediately after the injection of the mandibular anesthesia, and duration of facial weakness is less than 12 hours. However, there are few documented cases of PFNP after maxillary dental or surgical procedures. A variety of mechanisms have been associated to PFNP, including viral reactivation, demyelination, edema, vasospasm, and trauma. The purpose of this presentation was to report a rare case of facial paralysis that occurred after an upper third molar extraction. The cause of the PFNP and the importance of the multidisciplinary approach in the management are emphasized.
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Affiliation(s)
- Sirmahan Cakarer
- Department of Oral and Maxillofacial Surgery, Dentistry Faculty, Istanbul University, Istanbul, Turkey.
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