Intratympanic Steroid Treatment of Bell's Palsy in Patients with Comorbid Disease: A Preliminary Report

Peripheral Repetitive Transcranial Magnetic Stimulation(rTMS) for Idiopathic Facial Nerve Palsy: A Prospective, Randomized Controlled Trial

Purpose

The purpose of this study was to evaluate the clinical efficacy of peripheral repetitive transcranial magnetic stimulation (rTMS) in the treatment of idiopathic facial paralysis, to explore an ideal treatment scheme for idiopathic facial paralysis, and to provide evidence for clinical rehabilitation.

Methods

65 patients with idiopathic facial nerve palsy with the first onset were recruited and randomly divided into rTMS group and control group. Both groups received conventional treatment, rTMS group received additional repetitive transcranial magnetic stimulation to the affected side once a day, 5 times a week for 2 weeks. House-Brackmann (HB) grading scale, Sunnybrook facial grading system (SFGS), and modified Portmann scale (MPS) were used to assess facial nerve function before and after treatment, and the time for patients to return to normal facial nerve function and adverse reaction (AR) was also the main observation index.

Results

After a 2-week intervention, HB, SFGS, and MPS increased in both groups (P < 0.01); the improvement of HB, SFGS, and MPS in rTMS group was significantly higher than that in control group (P < 0.01). The effective improvement rate of the TMS group after 2 weeks was 90.0%, and that of the control group was 53.3%, and the difference was statistically significant (P < 0.01).

Conclusions

Repetitive transcranial magnetic stimulation is a safe and effective noninvasive method for the treatment of idiopathic facial paralysis, which can significantly accelerate the recovery of facial nerve function and provide a new treatment idea for further improving the prognosis of patients with idiopathic facial paralysis.

Intratympanic corticosteroid for Bell's palsy and Ramsay Hunt syndrome: Systematic review and meta-analysis

OBJECTIVE

This study aimed to reveal the efficacy and safety of intratympanic steroid therapy (ITST) in patients with Bell's palsy and Ramsay Hunt syndrome.

METHODS

A literature search was conducted in PubMed, Embase, Ichushi-Web, and Cochrane Central Register of Controlled Trials. Published randomized controlled trial and observational studies, which compared the combination of intratympanic corticosteroids with systemic corticosteroid versus systemic corticosteroid for Bell's palsy and Ramsay Hunt syndrome, were included for meta-analysis. The primary outcome was non-recovery at the end of the study follow-up. Data was analyzed using Review Manager software, and pooled odds ratio with 95% CI were calculated.

RESULTS

Three randomized controlled trial and two cohort studies met the eligible criteria, and 350 individuals included for meta-analysis. The timing of intratympanic corticosteroid was varied from once or twice a week to consecutive 10-days. Patients treated with combination of systemic corticosteroids and intratympanic corticosteroids were likely to achieve recovery of normal facial function (OR = 0.36 [95% CI 0.12-1.14]). The subgroup analysis of the timing revealed that daily ITST reduced non-recovery (OR = 0.14 [95% CI 0.04-0.50). However, non-daily ITST did not reduced non-recovery (OR 0.93 [95% CI 0.37-2.34]).

CONCLUSION

Intratympanic corticosteroid have a potential to reduce non-recovery in patients with Bell's palsy and Ramsay Hunt syndrome. The methods of intratympanic corticosteroid varied among included studies. Further well-designed randomized controlled trial is needed to confirm the effectiveness and to identify an adequate method of intratympanic corticosteroid in these patients.