[Accuracy of the prognostic diagnosis in acute peripheral facial palsy]

Taste and acoustic reflex after recovery from facial muscle paralysis in patients with facial nerve palsy

BACKGROUND

There are few studies on taste or acoustic reflex (AR) in patients after recovery from facial muscle paralysis (FMP).

OBJECTIVES

To investigate the recovery of AR and taste in patients who have recovered from peripheral facial nerve palsy (FNP).

MATERIALS AND METHODS

The study included 25 patients whose FMP had resolved after treatment for FNP. A difference in taste threshold of ≤4 dB between the affected and unaffected sides in the electric taste test was defined as normal; an AR on the affected side was assessed to be ≥90% of the AR on the unaffected side was defined as normal.

RESULTS

Six months after treatment, 8% of patients with FNP who had recovered from FMP still showed taste disorders, and 60% of patients showed abnormal AR. The number of subjects whose electric taste threshold was normal after treatment was significantly higher than the number of subjects whose AR assessment was normal (p < .01).

CONCLUSION AND SIGNIFICANCE

This study demonstrates that even among subjects whose FMP is resolved after treatment for FNP, there are some whose taste and AR do not recover. Physicians should be aware of ear symptoms persisting after facial muscle recovery.

Nerve Integrity Monitor Responses to Direct Facial Nerve Stimulation During Facial Nerve Decompression Surgery Can Predict Postoperative Outcomes

OBJECTIVE

To test whether the threshold of nerve integrity monitor (NIM) responses during facial nerve decompression surgery can predict the postoperative outcome.

STUDY DESIGN

Retrospective study.

SETTING

University hospital.

PATIENTS

Twenty peripheral facial palsy patients who underwent transmastoid decompression surgery.

INTERVENTION

During decompression surgery, thresholds of NIM responses were measured via direct facial nerve stimulation at three sites: the geniculate ganglion (GG), the second genu (2 G), and the stylomastoid foramen.

MAIN OUTCOME MEASURES

Facial nerve function was evaluated before and 6 months after surgery using the Yanagihara grading score (maximum score = 40 points). Complete recovery was defined as an improvement of the grading score to ≥ 36 points without synkinesis. Variables including age, sex, disease (Bell's palsy or Ramsay Hunt syndrome), time after onset, Yanagihara grading score, and electroneurography before surgery, and the thresholds of NIM responses during surgery were compared in the complete and incomplete recovery groups. NIM responders were defined as those exhibiting a NIM response of < 1.5 mA at any site. Postoperative Yanagihara grading scores in NIM responders and NIM nonresponders were compared.

RESULTS

No variables differed significantly in the complete and incomplete recovery groups before surgery. NIM response thresholds in the complete recovery group at the GG and the 2nd G were significantly lower than the corresponding thresholds in the incomplete recovery group. The postoperative Yanagihara grading scores of NIM responders were significantly better than those of NIM nonresponders.

CONCLUSION

NIM responses to intraoperative direct facial nerve stimulation were useful for predicting outcomes after decompression surgery.

Prognostic factors of Bell's palsy and Ramsay Hunt syndrome

The aim of this study was to compare clinical characteristics, electroneurography (ENoG) results, and functional outcomes of patients with Bell's palsy (BP) and Ramsay Hunt syndrome (RHS).Around 57 patients with BP and 23 patients with RHS were enrolled in this study from January 2010 and September 2015. Both clinical characteristics and ENoG results were recorded at hospital admission. The evaluations of functional outcomes were conducted with House-Brackmann (H-B) grading system at 6-month follow-up.There were no significant differences in age, gender proportion, initial H-B grades, time before commencement of treatment and the presence of comorbid disease in 2 groups. However, the final H-B grades at 6-month follow-up were significantly better in BP patients than RHS patients. The results of ENoG showed that degeneration index (DI) was significantly higher in the RHS group than the BP group. But no significant difference was found in the value of prolonged latency time (PLT) between the 2 groups. In multivariate analysis, age and ENoG DI were independently associated with functional outcome of recovery in the BP group (OR 0.167, 95% CI 0.038-0.622, P = 0.009 and OR 0.289 95% CI 0.107-0.998, P = 0.050, respectively). However, in the RHS group, only ENoG DI was related to the final H-B grades (OR 0.067, 95% CI 0.005-0.882, P = 0.040). Spearman's rank correlation analysis showed that higher age and ENoG DI were related to poorer prognosis in 2 groups (P < 0.05). PLT was related to functional outcomes only in the BP group (rs = 0.460, P < 0.001). The receiver operating characteristic (ROC) of ENoG DI analysis revealed that the cutoff value was 67.0% for BP prognosis and 64.5% for RHS prognosis. What's more, patients with hypertension or diabetes mellitus had both higher final H-B grade and ENoG DI than those without the same comorbidity.Patients with RHS had poorer prognosis than those with BP. Some factors including age, ENoG DI, and the presence of disease influenced recovery from BP and RHS. The present study demonstrated that BP patients with ENoG DI < 67.0% and RHS patients with ENoG DI < 65.5% had a greater opportunity for recovery within half a year.

A Clinical Study of Bell's Palsy and Factors Influencing its Prognosis

We encountered 185 patients with Bell's palsy at our hospital between January 2003 and December 2005. Of these patients, 60% visited our department within 3 days of the onset, and 90% within 7 days of the onset; the interval from onset to hospital visit showed no relation with the severity of the paralysis. Complete recovery was obtained in 85.0% of the patients with steroid or steroid + antiviral treatment. Preservation of the stapedius reflex was a statistically significant predictor of good prognosis, with a high positive predictive value (95.5%). Several factors influencing the prognosis were examined with a Cox's proportional hazards model. The factors considered were the sex of the patients, left / right localization, age, postauricular pain, eye symptoms, taste disorder, underlying diabetes, the Yanagihara facial grading system score, and use of antiviral drugs. The analysis revealed only the Yanagihara score and antiviral drug use as statistically important, with hazard ratios of 1.101 and 1.586, respectively. Although this study had several limitations, steroid + antiviral treatment could yield a better prognosis as compared to steroid treatment alone.