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Kwak MY, Lee HY, Lee SA, Jeong J, Chung JH, Kim J, Jun BC, Yeo SG, Kim SH, Lee JD. The Impact of the COVID-19 Pandemic on Bell's Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study. J Korean Med Sci 2024; 39:e140. [PMID: 38685888 PMCID: PMC11058340 DOI: 10.3346/jkms.2024.39.e140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This article presents a comprehensive review of data on the impact of facial palsy during the coronavirus disease 2019 (COVID-19) pandemic. The possible causes and pathophysiological mechanisms of changes in the epidemiology of facial palsy during the COVID-19 pandemic are also discussed. METHODS This multicenter retrospective cohort study included 943 patients diagnosed with Bell's palsy or Ramsay Hunt syndrome. This study compared patient demographics, comorbidities, symptoms, and treatments before the COVID-19 pandemic (from 2017 to 2019) and during the COVID-19 pandemic, from 2020 to 2022). RESULTS Following the COVID-19 outbreak, there has been a significant increase in the number of cases of Bell's palsy, particularly among elderly individuals with diabetes. Bell's palsy increased after the COVID-19 outbreak, rising from 75.3% in the pre-COVID-19 era to 83.6% after the COVID-19 outbreak. The complete recovery rate decreased from 88.2% to 73.9%, and the rate of recurrence increased from 2.9% to 7.5% in patients with Bell's palsy. Ramsay Hunt syndrome showed fewer changes in clinical outcomes. CONCLUSION This study highlights the impact of the COVID-19 pandemic on the presentation and management of facial palsy, and suggests potential associations with COVID-19. Notably, the observed increase in Bell's palsy cases among elderly individuals with diabetes emphasizes the impact of the pandemic. Identifying the epidemiological changes in facial palsy during the COVID-19 pandemic has important implications for assessing its etiology and pathological mechanisms of facial palsy disease.
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Affiliation(s)
- Min Young Kwak
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Ho Yun Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University Faculty of Medicine, Seoul, Korea
| | - Se A Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Junhui Jeong
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Ho Chung
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jin Kim
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Beom Cho Jun
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Geun Yeo
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang Hoon Kim
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
| | - Jong Dae Lee
- The Facial Nerve Disorder Subcommittee, The Quality Control Committee of the Korean Otologic Society, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea.
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Fann LY, Wen YL, Huang YC, Cheng CC, Huang YC, Fang CC, Chen WT, Yu PY, Pan HY, Kao LT. Depressive disorder and elevated risk of bell's palsy: a nationwide propensity score-weighting study. BMC Psychiatry 2024; 24:284. [PMID: 38627723 PMCID: PMC11020612 DOI: 10.1186/s12888-024-05730-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Prior studies have reported a potential relationship between depressive disorder (DD), immune function, and inflammatory response. Some studies have also confirmed the correlation between immune and inflammatory responses and Bell's palsy. Considering that the pathophysiology of these two diseases has several similarities, this study investigates if DD raises the risk of developing Bell's palsy. METHODS This nationwide propensity score-weighting cohort study utilized Taiwan National Health Insurance data. 44,198 patients with DD were identified as the DD cohort and 1,433,650 adult subjects without DD were identified as the comparison cohort. The inverse probability of treatment weighting (IPTW) strategy was used to balance the differences of covariates between two groups. The 5-year incidence of Bell's palsy was evaluated using the Cox proportional-hazard model, presenting results in terms of hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS The average age of DD patients was 48.3 ± 17.3 years, and 61.86% were female. After propensity score-weighting strategy, no significant demographic differences emerged between the DD and comparison cohort. The Cox proportional hazards model revealed a statistically significant adjusted IPTW-HR of 1.315 (95% CI: 1.168-1.481) for Bell's palsy in DD patients compared to comparison subjects. Further independent factors for Bell's palsy in this model were age (IPTW-HR: 1.012, 95% CI: 1.010-1.013, p < 0.0001), sex (IPTW-HR: 0.909, 95% CI: 0.869-0.952, p < 0.0001), hypertension (IPTW-HR: 1.268, 95% CI: 1.186-1.355, p < 0.0001), hyperlipidemia (IPTW-HR: 1.084, 95% CI: 1.001-1.173, p = 0.047), and diabetes (IPTW-HR: 1.513, 95% CI: 1.398-1.637, p < 0.0001) CONCLUSION: This Study confirmed that individuals with DD face an elevated risk of developing Bell's palsy. These findings hold significant implications for both clinicians and researchers, shedding light on the potential interplay between mental health and the risk of certain physical health outcomes.
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Affiliation(s)
- Li-Yun Fann
- Department of Nursing, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yuan-Liang Wen
- School of Pharmacy, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, 114201, Taipei City, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chieh Huang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - Chih-Chien Cheng
- University of Taipei, Taipei, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Obstetrics/Gynecology, Taipei City Hospital, Taipei, Taiwan
| | - Ying-Che Huang
- Department of Anesthesia and Critical Care Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - Chih-Chia Fang
- Department of Nursing, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - Wan-Ting Chen
- Department of Nursing, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
| | - Pei-Yeh Yu
- Department of Anesthesiology, Taipei City Hospital Ren Ai branch, Taipei, Taiwan
| | - Hsiang-Yi Pan
- Department of Pharmacy Practice, Tri-Service General Hospital, No.325, Sec.2, Chenggong Rd., Neihu District, 114202, Taipei City, Taiwan.
| | - Li-Ting Kao
- School of Pharmacy, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist, 114201, Taipei City, Taiwan.
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
- Department of Pharmacy Practice, Tri-Service General Hospital, No.325, Sec.2, Chenggong Rd., Neihu District, 114202, Taipei City, Taiwan.
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Babl FE, Eapen N, Herd D, Borland ML, Kochar A, Lawton B, Hort J, West A, George S, Davidson A, Cheek JA, Oakley E, Hopper SM, Berkowitz RG, Wilson CL, Williams A, MacKay MT, Lee KJ, Hearps S, Dalziel SR. Pain in children with Bell's palsy: secondary analysis of a randomised controlled trial. Arch Dis Child 2024; 109:227-232. [PMID: 38049992 DOI: 10.1136/archdischild-2023-325381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE To describe the prevalence and severity of pain experienced by children with Bell's palsy over the first 6 months of illness and its association with the severity of facial paralysis. METHODS This was a secondary analysis of data obtained in a phase III, triple-blinded, randomised, placebo-controlled trial of prednisolone for the treatment of Bell's palsy in children aged 6 months to <18 years conducted between 13 October 2015 and 23 August 2020 in Australia and New Zealand. Children were recruited within 72 hours of symptom onset and pain was assessed using a child-rated visual analogue scale (VAS), a child-rated Faces Pain Score-Revised (FPS-R) and/or a parent-rated VAS at baseline, and at 1, 3 and 6 months until recovered, and are reported combined across treatment groups. RESULTS Data were available for 169 of the 187 children randomised from at least one study time point. Overall, 37% (62/169) of children reported any pain at least at one time point. The frequency of any pain reported using the child-rated VAS, child-rated FPS-R and parent-rated VAS was higher at the baseline assessment (30%, 23% and 27%, respectively) compared with 1-month (4%, 0% and 4%, respectively) and subsequent follow-up assessments. At all time points, the median pain score on all three scales was 0 (no pain). CONCLUSIONS Pain in children with Bell's palsy was infrequent and primarily occurred early in the disease course and in more severe disease. The intensity of pain, if it occurs, is very low throughout the clinical course of disease. TRIAL REGISTRATION NUMBER ACTRN12615000563561.
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Affiliation(s)
- Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Nitaa Eapen
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - David Herd
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Perth, Australia
- Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Amit Kochar
- Department of Acute Care Medicine, University of Adelaide, Adelaide, South Australia, Australia
- Emergency Department, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Ben Lawton
- Emergency Department, Logan Hospital, Brisbane, Queensland, Australia
| | - Jason Hort
- Emergency Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Adam West
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia
| | - Shane George
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Andrew Davidson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Anesthesia and Pain Management, Royal Children's Hospital, Parkville, Victoria, Australia
| | - John A Cheek
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy M Hopper
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Robert G Berkowitz
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Williams
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark T MacKay
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine J Lee
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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Kalavacherla S, Du E, de Cos V, Meller L, Ostrander B, Davis M, Greene J. The Rate of Occult Lesion Diagnosis in a Large Bell's Palsy Cohort. Laryngoscope 2024; 134:911-918. [PMID: 37470296 PMCID: PMC11023743 DOI: 10.1002/lary.30895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/06/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES We characterize occult lesion diagnosis rates after initial Bell's palsy diagnoses. METHODS A de-identified database of all facial palsy patients who presented to an extensive health care system across 22 years was created using Epic SlicerDicer. Among patients with Bell's palsy diagnoses, we extracted demographic and any subsequent occult lesion diagnosis data across various clinical sites. Descriptive and multivariable regression analyses comparing patients with occult lesion diagnoses made at different time points were included. RESULTS Among the total 3912 facial palsy patients, 2240 had Bell's palsy diagnoses, of which 217 (9.7%) had subsequent lesion diagnoses at a median (IQR) of 12.3 (4.2, 23.8) months, consisting of cranial nerve neoplasms (62.2%), parotid gland neoplasms (34.1%), and cholesteatomas (3.7%). Although a large proportion of total lesions were diagnosed within the first 3 months (19.8%), 69.5% were diagnosed after 6 months. There were no demographic differences among patients diagnosed with different lesion types, but Asian patients were more likely to be diagnosed with occult lesions after 12 months after Bell's palsy diagnosis compared with white patients (odds ratio = 6.2, p = 0.001). CONCLUSIONS In one of the largest Bell's palsy cohorts to date, we identified a 9.7% occult lesion diagnosis rate at a median of 12.3 months after Bell's palsy diagnosis. These data underscore the importance of timely workup for occult lesions in cases of facial palsy with no signs of recovery after 3-4 months. LEVEL OF EVIDENCE 4 Laryngoscope, 134:911-918, 2024.
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Affiliation(s)
- Sandhya Kalavacherla
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Eric Du
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Víctor de Cos
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Leo Meller
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Benjamin Ostrander
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Morgan Davis
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Jacqueline Greene
- Department of Otolaryngology-Head & Neck Surgery, University of California San Diego, San Diego, California, USA
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Rajangam J, Lakshmanan AP, Rao KU, Jayashree D, Radhakrishnan R, Roshitha B, Sivanandy P, Sravani MJ, Pravalika KH. Bell Palsy: Facts and Current Research Perspectives. CNS Neurol Disord Drug Targets 2024; 23:203-214. [PMID: 36959147 DOI: 10.2174/1871527322666230321120618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/25/2023]
Abstract
Bell palsy is a non-progressive neurological condition characterized by the acute onset of ipsilateral seventh cranial nerve paralysis. People who suffer from this type of facial paralysis develop a droop on one side of their face, or sometimes both. This condition is distinguished by a sudden onset of facial paralysis accompanied by clinical features such as mild fever, postauricular pain, dysgeusia, hyperacusis, facial changes, and drooling or dry eyes. Epidemiological evidence suggests that 15 to 23 people per 100,000 are affected each year, with a recurrence rate of 12%. It could be caused by ischaemic compression of the seventh cranial nerve, which could be caused by viral inflammation. Pregnant women, people with diabetes, and people with respiratory infections are more likely to have facial paralysis than the general population. Immune, viral, and ischemic pathways are all thought to play a role in the development of Bell paralysis, but the exact cause is unknown. However, there is evidence that Bell's hereditary proclivity to cause paralysis is a public health issue that has a greater impact on patients and their families. Delay or untreated Bell paralysis may contribute to an increased risk of facial impairment, as well as a negative impact on the patient's quality of life. For management, antiviral agents such as acyclovir and valacyclovir, and steroid treatment are recommended. Thus, early diagnosis accompanied by treatment of the uncertain etiology of the disorder is crucial. This paper reviews mechanistic approaches, and emerging medical perspectives on recent developments that encounter Bell palsy disorder.
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Affiliation(s)
- Jayaraman Rajangam
- AMITY Institute of Pharmacy, AMITY University, Lucknow, Uttar Pradesh, 226028, India
| | | | - K Umamaheswara Rao
- Department of Pharmacology, Sri Venkateswara Institute of Medical Sciences, Sri Padmavati Mahila Visvavidyalayam, Tirupati, Andhra Pradesh, 517507, India
| | - D Jayashree
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, P.O Box 505055, Dubai, UAE
| | - B Roshitha
- Sri Venkateswara Institute of Cancer Care and Advanced Research, Tirupati, Andhra Pradesh, 517507, India
| | - Palanisamy Sivanandy
- School of Pharmacy, International Medical University, No 126, Jalan Jalil Perkasa 19, Bukit Jalil 57000 Kuala Lumpur, Malaysia
| | - M Jyothi Sravani
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
| | - K Hanna Pravalika
- Sree Vidyanikethan College of Pharmacy - Tirupati, Andhra Pradesh-517501, India
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Balchander D, Cabrera CI, Qureshi H, Perez JA, Goslawski A, Tranchito E, Johnson BR, Tamaki A, Rabbani CC. Bell's Palsy and COVID-19: Insights from a Population-Based Analysis. Facial Plast Surg Aesthet Med 2024; 26:41-46. [PMID: 37751178 DOI: 10.1089/fpsam.2022.0394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) has been linked to Bell's palsy and facial paralysis. Studies have also shown increased risk of Bell's palsy in unvaccinated COVID-19 patients. Objective: To compare the relationship between Bell's palsy and COVID-19 infection and vaccination. Design: This is a retrospective longitudinal study. Methods: The COVID-19 research network was used to identify patients with facial palsy presenting to 70 health care organizations in the United States. The incidence of Bell's palsy was measured within an 8-week window after COVID-19 test or vaccination event in identified patients. Results: Incidence of facial palsy diagnosis (0.99%) was higher than the background rate within 2 months of COVID-19 infection. When compared with their negative counterparts, patients with COVID-19 infection had significantly higher risk of Bell's palsy (risk ratio [RR] = 1.77, p < 0.01) and facial weakness (RR = 2.28, p < 0.01). Risk ratio was also amplified when evaluating Bell's palsy (RR = 12.57, p < 0.01) and facial palsy (RR = 44.43; p < 0.01) in COVID-19-infected patients against patients who received COVID-19 vaccination. Conclusion: In our patient population, there is a higher risk of developing facial palsy within 2 months of COVID-19 infection versus vaccination. Vaccinated patients are not at higher risk of developing facial palsy.
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Affiliation(s)
- Divya Balchander
- Drexel University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Hira Qureshi
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jaime A Perez
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Amanda Goslawski
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Eve Tranchito
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Benjamin R Johnson
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Cyrus C Rabbani
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Lassaletta L, Sánchez-Cuadrado I, Mato-Patino T, Peñarrocha J, Angélica Rivera-Núñez M, María Torres Santos-Olmo R, Gavilán J, Manuel Morales-Puebla J, Group COHC. Has Coranavirus Disease 2019 Changed the Incidence and Outcome of Bell's Palsy? J Int Adv Otol 2024; 20:19-25. [PMID: 38454284 PMCID: PMC10895820 DOI: 10.5152/iao.2024.231254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/23/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Objectives: (1) To determine whether the incidence of Bell's Palsy (BP) increased during the pandemic. (2) To investigate whether the outcomes of patients with BP and COVID-19 infection or vaccination differ from those in the pre-pandemic era. METHODS Patients with BP were studied in 2 periods retrospectively (March 2021-March 2022 and August 2018-August 2019). A prospective study from March 2021 to March 2022 was also performed. Primary outcome was grade ≤Ⅱ in the House-Brackmann (HB) and/or >70 in the Sunnybrook facial grading system (SFGS) scales at the 12-week visit. Reverse transcriptase polymerase chain reaction (PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and enzyme-linked immunosorbent assay-based SARS-CoV-2 immuonoglobulin G (IgG) test (blood) were measured. RESULTS About 162 and 196 patients with BP were identified between March 2021 and March 2022 and August 2018 and August 2019, respectively. Forty-seven patients (29%) entered the prospective study; 85% had HB grades I or II, while 92% had an SFGS score of 71-100 at the last visit. Only 3 patients (6.5%) had a positive PCR during the initial episode, whereas 35 patients (77%) had positive IgG SARS-CoV-2. There was no association between positive PCR and facial function outcomes. Of the 162 patients, 105 (67%) had received COVID-19 vaccine. In 23 of them (22%), the paralysis appeared within the first 30 days after a vaccine dose. CONCLUSION Coronavirus disease 2019 did not increase the incidence of BP. A direct association between the coronavirus and BP outcome cannot be established. The considerable number of patients developing BP within the first month suggests a possible association between COVID-19 vaccines and BP.
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Affiliation(s)
- Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain, IdiPAZ Research Institute, Madrid, Spain, Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Isabel Sánchez-Cuadrado
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain, IdiPAZ Research Institute, Madrid, Spain
| | - Teresa Mato-Patino
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
| | - Julio Peñarrocha
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
| | | | | | - Javier Gavilán
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
| | - José Manuel Morales-Puebla
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain, IdiPAZ Research Institute, Madrid, Spain, Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
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8
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Kim S, Kang M, Park JS, Seok HY. Risk and characteristics of Bell's palsy in adults as an adverse event following COVID-19 vaccination: a retrospective study. Acta Neurol Belg 2023; 123:2185-2193. [PMID: 36781626 PMCID: PMC9924857 DOI: 10.1007/s13760-023-02204-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND Although an association between COVID-19 vaccination and Bell's palsy (BP) has been reported, a clear causal relationship has not been elucidated. We investigated the risk and clinical characteristics of BP after COVID-19 vaccination. METHODS This retrospective chart review evaluated the association between COVID-19 vaccination and BP by comparing the number of patients diagnosed with BP during the pre-COVID-19 vaccination period (March 2018-February 2021) and the COVID-19 mass vaccination period (March 2021-February 2022). We then compared vaccine-related (time between vaccination and BP onset < 42 days) and -unrelated (time interval ≥ 42 days or non-vaccination) clinical characteristics in newly diagnosed patients with BP. RESULTS BP occurred more during the COVID-19 vaccination period than in the previous three pre-vaccination years. Thirteen patients developed BP within 42 days of vaccination. All patients, except one, developed BP after mRNA-based vaccination, with most cases (9/13, 69.2%) occurring after the second or third dose. Thirteen patients with vaccine-related BP were younger (age 43.92 ± 13.14 vs. 54.32 ± 16.01 years; p = 0.033) and more frequently experienced taste changes (58.8% vs. 10.9%; p = 0.002) than 52 patients with vaccine-unrelated BP. Patients with vaccine-related BP had a greater likelihood of good and faster (p = 0.042) facial nerve function recovery than those with vaccine-unrelated BP (100% vs. 78%). CONCLUSION COVID-19 vaccines, especially mRNA-based vaccines, may be associated with BP cases with distinctive clinical characteristics, which occur more frequently in young individuals, are frequently accompanied by taste changes, and have fast and good recovery.
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Affiliation(s)
- Sohyeon Kim
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Minsung Kang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-Ro, Buk-Gu, Daegu, 41404, Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-Ro, Buk-Gu, Daegu, 41404, Korea.
| | - Hung Youl Seok
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.
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Kim HJ, Jeong S, Song J, Park SJ, Oh YH, Jung J, Choi NK, Park SM. Risk of Bell's palsy following SARS-CoV-2 infection: a nationwide cohort study. Clin Microbiol Infect 2023; 29:1581-1586. [PMID: 37611865 DOI: 10.1016/j.cmi.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Despite some evidence of an increased risk of neurologic symptoms following viral vector COVID-19 vaccine administration, it is unclear whether SARS-CoV-2 infection is associated with Bell's palsy (BP), especially over a long enough follow-up period. METHODS The study population of this nationwide population-based study was derived from the South Korean population, including 11 593 365 and 36 565 099 participants with and without COVID-19, respectively. The Fine and Gray's regression model was utilized to calculate the adjusted subdistribution hazard ratio (aSHR), considering death as a competing risk, to assess the association between SARS-CoV-2 infection and the risk of BP. All participants were followed up from 1 December 2021, until the incident BP, SARS-CoV-2 infection, death, or 31 March 2022. Subgroup analyses were conducted based on participants' vaccination status (completion of the primary series vs. unvaccinated). RESULTS COVID-19 was associated with an increased risk of BP in all participants (aSHR, 1.24; CI, 1.19-1.29). However, the size of the COVID-19-related BP risk was significantly lower among those who completed the primary series of the COVID-19 vaccine (aSHR, 1.20; 95% CI, 1.15-1.25) compared to those who were unvaccinated (aSHR, 1.84; 95% CI, 1.59-2.12; p for interaction: <0.001). The severity of COVID-19 exhibited a gradual escalation in BP risk for both vaccinated and unvaccinated individuals. DISCUSSION While both unvaccinated individuals and those who completed the primary series of the COVID-19 vaccine may be at an increased risk of developing BP due to COVID-19, the risk appears to be lower among those who completed the vaccination.
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Affiliation(s)
- Hye Jun Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, South Korea
| | - Jihun Song
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
| | - Yun Hwan Oh
- Department of Family Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
| | - Jaehun Jung
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea
| | - Nam-Kyong Choi
- Department of Health Convergence College of Science and Industry Convergence, Ewha Womans University, Seoul, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea; Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.
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10
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Chen J, Yu Z, Zhou W, Cai H, Jin F, Hu J, Yu E, Xuan L. Effect of temperature and air pressure on the incidence of Bell's palsy in Hangzhou: a distributed lag non-linear analysis. Sci Rep 2023; 13:20424. [PMID: 37993478 PMCID: PMC10665392 DOI: 10.1038/s41598-023-47570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
The etiology of Bell's palsy (BP) is currently unknown, and the findings from previous studies examining the association between seasonal or meteorological factors and BP have been inconsistent. This research aims to clarify this relationship by analyzing a larger dataset and employing appropriate statistical methods. Data from 5387 patients with BP treated at Zhejiang Provincial Hospital of Traditional Chinese Medicine in Hangzhou, Zhejiang Province, from May 1, 2018, to June 30, 2023, was gathered. We assessed the temporal distribution of meteorological factors and the incidence of BP across seasons and months. A distributed lag non-linear model was used to further investigate the lagged and overall effects of temperature and air pressure on the onset of BP. The temporal distribution of BP incidence revealed the highest average number of cases occurring in December and the lowest in June. A correlation existed between BP episodes and temperature or air pressure. The model revealed a higher relative risk during periods of low temperature and high air pressure, characterized by a time lag effect. This correlation was notably more pronounced in female patients and individuals in the young and middle-aged groups. Our findings suggest that exposure to low temperatures and high air pressure constitute risk factors for BP development.
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Affiliation(s)
- Junkang Chen
- The First School of Clinical Medicine of Zhejiang, Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Zhexuan Yu
- The First School of Clinical Medicine of Zhejiang, Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Wenhui Zhou
- The First School of Clinical Medicine of Zhejiang, Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Huafeng Cai
- The First School of Clinical Medicine of Zhejiang, Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Fanyuan Jin
- The First School of Clinical Medicine of Zhejiang, Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Jinhua Hu
- The First School of Clinical Medicine of Zhejiang, Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Erhui Yu
- The First School of Clinical Medicine of Zhejiang, Chinese Medical University, Hangzhou, 310053, Zhejiang, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, Zhejiang, China.
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11
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Seo HW, Ryu S, Lee SH, Chung JH. Diabetes Mellitus and Acute Facial Palsy: A Nationwide Population-Based Study. Neuroepidemiology 2023; 58:37-46. [PMID: 37992696 DOI: 10.1159/000534760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/17/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Acute facial palsy, characterized by sudden hemifacial weakness, significantly impacts an individual's quality of life. Despite several predisposing factors identified for acute facial palsy, the specific relationship between diabetes mellitus (DM) and acute facial palsy has not been comprehensively explored in recent studies. The aim of the study was to assess the risk of acute facial palsy in patients with DM using a nationwide population sample cohort. METHODS DM cohort and non-DM cohort were built using the Korean National Health Insurance Service-Sample Cohort which represents the entire population of the Republic of Korea from January 2002 to December 2019. The DM cohort comprised 92,872 patients with a record of medication and a diagnosis of DM. Individuals who had facial palsy before the diagnosis of DM were excluded. A comparison cohort comprised 1,012,021 individuals without DM matched sociodemographically in a 1:4 ratio. The incidence of Bell's palsy (BP) and Ramsay Hunt syndrome (RHS) were evaluated in both cohorts. The risk factors for acute facial palsy were also assessed. RESULTS Among the 92,868 patients in the DM cohort, the incidence rate (IR) of BP and RHS were 31.42 (confidence interval [CI], 30.24-32.63) and 4.58 per 10,000 person-years (CI, 4.14-5.05), respectively. Among the 371,392 individuals in the non-DM cohort, the IR of BP was 22.11 per 10,000 person-years (CI, 21.62-22.59) and the IR of RHS was 2.85 per 10,000 person-years (CI, 2.68-3.02). IR ratios for BP and RHS were 1.42 (CI, 1.36-1.48) and 1.61 (CI, 1.43-1.80). In multivariate analysis, DM (hazard ratio [HR] 1.428), age (HR 1.008), and high comorbidity score (HR 1.051) were associated with increased risk of BP, and male (HR 0.803) and living in metropolis (HR 0.966) decreased the risk of BP. And DM (HR 1.615), high comorbidity score (HR 1.078), and living in metropolis (HR 1.201) were associated with increased risk for RHS. CONCLUSION This study suggests that patients with DM had an increased risk of acute facial palsy including BP and RHS.
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Affiliation(s)
- Hee Won Seo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Soorack Ryu
- Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hwan Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jae Ho Chung
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
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12
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Gordon AJ, Varelas A, Eytan DF. Bell's Palsy After Vaccination Against Covid-19: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 169:1114-1121. [PMID: 37272720 DOI: 10.1002/ohn.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/20/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to identify studies reporting the incidence of Bell's Palsy after vaccination against coronavirus disease 2019 (Covid-19) and assess whether this incidence is greater than among the general population. DATA SOURCES PubMed, Embase, CINAHL, and Web of Science. REVIEW METHODS A systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases were searched from inception to May 9, 2022, for studies reporting the incidence of Bell's Palsy among individuals vaccinated against Covid-19 and control populations. Meta-analyses of odds ratios (ORs) were performed to compare the incidence of Bell's Palsy in these groups. RESULTS We identified 7 studies reporting the incidence of Bell's Palsy after vaccination and among the general population, including 20,234,931 total vaccinated patients. The length of postvaccination follow-up ranged from 7 to 43 days in these studies. The incidence of Bell's Palsy was not significantly greater among vaccinated individuals (OR: 1.06; 95% confidence interval [CI]: 0.65-1.71; p = .82). Stratifying by dose, the incidence of Bell's Palsy was not significantly greater after receiving either the first dose (OR: 0.84; 95% CI: 0.47-1.49; p = .54) or second dose (OR: 1.02; 95% CI: 0.58-1.79; p = .96). CONCLUSION Among the available evidence, the incidence of Bell's Palsy after vaccination against Covid-19 is comparable to that of the general unvaccinated population. Patient counseling should provide reassurance that there is no known association between Bell's Palsy and Covid-19 vaccination.
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Affiliation(s)
- Alex J Gordon
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, NYU Grossman School of Medicine, New York City, New York, USA
| | - Antonios Varelas
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, NYU Grossman School of Medicine, New York City, New York, USA
| | - Danielle F Eytan
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, NYU Grossman School of Medicine, New York City, New York, USA
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13
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Qureshi H, Balchander D, Cabrera CI, Tranchito E, Goslawski A, Vos D, Johnson B, Fowler N, Tamaki A, Rabbani CC. Examining the relationship between COVID-19 and Bell's palsy: Experience of a single tertiary care center. Am J Otolaryngol 2023; 44:103987. [PMID: 37579600 DOI: 10.1016/j.amjoto.2023.103987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND While the etiology of Bell's palsy (BP) is largely unknown, current evidence shows it may occur secondary to the immune response following a viral infection. Recently, BP has been reported as a clinical manifestation of coronavirus disease (COVID-19). OBJECTIVES To investigate an association between COVID-19 infection and BP. Additionally, to evaluate the need for COVID-19 testing in patients who present with BP. METHODS Hospital records of patients who presented to a single tertiary care center with BP in 2020 and 2021 were reviewed for presenting symptoms, demographics, COVID-19 infection and vaccination status. RESULTS There was no statistically significant difference between patients with BP who had a positive or negative COVID test in terms of sex, BMI, age, race, smoking history or alcohol use. All 7 patients with BP and a positive COVID test were unvaccinated. Of the total cohort of 94 patients, 82 % were unvaccinated at the time of the study. None of the 17 patients who were vaccinated had a positive COVID test. A history of BP showed no statistical significance (10.3 % vs 14.3 %, p-value 0.73). CONCLUSION We discovered a limited cohort of patients who underwent COVID-19 testing at the time of presentation for BP. Though there have been recent studies suggesting a COVID-19 and BP, we were unable to clearly identify a relationship between COVID-19 and BP. Interestingly, all patients with facial paralysis and COVID-19 were unvaccinated. To further study this relationship, we recommend consideration of a COVID-19 test for any patient that presents with facial paralysis.
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Affiliation(s)
- Hira Qureshi
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | | | - Claudia I Cabrera
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Eve Tranchito
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amanda Goslawski
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Derek Vos
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Benjamin Johnson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Nicole Fowler
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Akina Tamaki
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Cyrus C Rabbani
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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14
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Jeong J, Yoon SR, Lim H, Nam Y, Choi HS. Risk for depression and anxiety in patients with facial palsy based on population-based data from Korea. Acta Otolaryngol 2023; 143:1001-1004. [PMID: 38240110 DOI: 10.1080/00016489.2024.2302899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Several studies point out the association of facial palsy with psychiatric distress such as depression and anxiety. However, there have been few studies on this association based on population-based data. OBJECTIVES To investigate the risk for depression and anxiety disorders in patients with Bell's palsy and in those with Ramsay Hunt syndrome. MATERIALS AND METHODS This retrospective study included data from the Korean National Health Insurance Service National Sample Cohort. From 2006 to 2015, patients with Bell's palsy and those with Ramsay Hunt syndrome were defined using diagnostic and medication claim codes. Patients with depression or anxiety were defined using diagnostic and medication claim codes. Occurrences of depression and anxiety were included in analyses. RESULTS There were significantly higher risks for depressive and anxiety disorders in the group of patients with Bell's palsy than in the control group, as well as in the group of patients with Ramsay Hunt syndrome than in the control group. CONCLUSIONS AND SIGNIFICANCE There were significantly higher risks for depression and anxiety in patients with facial palsy including Bell's palsy and Ramsay Hunt syndrome based on population-based data from Korea.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - So Ra Yoon
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyunsun Lim
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yunbin Nam
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hyun Seung Choi
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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15
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Jeong J, Lee YH, Kim S, Kim SH, Chang KH. Sudden Sensorineural Hearing Loss and Facial Palsy in Patients with Vestibular Schwannoma Based on the Population Data of Korea. J Int Adv Otol 2023; 19:468-471. [PMID: 38088318 PMCID: PMC10765230 DOI: 10.5152/iao.2023.231121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The prevalence of sudden sensorineural hearing loss and facial palsy in patients with vestibular schwannoma and the association of sudden sensorineural hearing loss or facial palsy with vestibular schwannoma were investigated based on the population data of Korea. METHODS This retrospective study used the Korean National Health Insurance Service data. Patients with vestibular schwannoma and those with a previous history of sudden sensorineural hearing loss or facial palsy were identified based on diagnostic, medication, magnetic resonance imaging, or audiometric codes from 2005 to 2020. The control group was established with propensity score matching. The risk for vestibular schwannoma in patients with a previous history of sudden sensorineural hearing loss or facial palsy was analyzed. RESULTS There were 5751 patients in the vestibular schwannoma group and 23004 in the control group. The rate of patients with a previous history of sudden sensorineural hearing loss in the vestibular schwannoma group (25.8%) was significantly higher than in the control group (P -lt; .0001), as was the rate of patients with a previous history of facial palsy in the vestibular schwannoma group (4.7%) (P -lt; .0001). Previous history of sudden sensorineural hearing loss was a significant risk factor for vestibular schwannoma (hazard ratio=7.109, 95% confidence interval=6.696-7.547). Previous history of facial palsy was also a significant risk factor for vestibular schwannoma (hazard ratio=3.048, 95% confidence interval=2.695-3.447). CONCLUSION The prevalence of sudden sensorineural hearing loss or facial palsy was significantly higher in patients with vestibular schwannoma than in those without vestibular schwannoma. Based on the population data of Korea, sudden sensorineural hearing loss and facial palsy were significant risk factors for vestibular schwannoma.
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Affiliation(s)
- Junhui Jeong
- Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yun-Hee Lee
- Department of Urology, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Subin Kim
- Department of Otorhinolaryngology, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Seung Hwa Kim
- Department of Otorhinolaryngology, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Ki-Hong Chang
- Department of Otorhinolaryngology, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul, Korea
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16
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Hu C, Wei KC, Wang WH, Chang YC, Huang YT. Association of Influenza Vaccination With Risk of Bell Palsy Among Older Adults in Taiwan. JAMA Otolaryngol Head Neck Surg 2023; 149:726-734. [PMID: 37347468 PMCID: PMC10288376 DOI: 10.1001/jamaoto.2023.1392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2023]
Abstract
Importance Annual administration of the influenza vaccine (fluVc) is currently the most effective method of preventing the influenza virus in older adults. However, half of adults older than 65 years remain unvaccinated in Taiwan, possibly because of concern about adverse events, such as Bell palsy (BP). Currently, studies on the association between fluVc and risk of BP are inconsistent. Objective To determine whether the incidence of BP increases following fluVc in older adults. Design, Setting, and Participants A self-controlled case series study design was used. Days 1 through 7, days 8 through 14, days 15 through 30, and days 31 through 60 following fluVc were identified as risk intervals, and days 61 through 180 were considered the control interval. A total of 4367 vaccinated individuals aged 65 years or older who developed BP within 6 months following fluVc were enrolled. Population-based retrospective claims data were obtained between 2010 and 2017; data were analyzed from April 2022 through September 2022. Exposure Government-funded seasonal fluVc. Main Outcomes and Measures The outcome of interest was BP onset in risk intervals compared with control intervals. Three or more consecutive diagnoses of BP within 60 days following fluVc were used as the definition of a patient with BP. Poisson regression was used to analyze the incidence rate ratio (IRR) of risk intervals compared with control intervals. Results In total, 13 261 521 patients who received the fluVc were extracted from the National Health Insurance Research Database in Taiwan from January 1, 2010, to December 31, 2017. Of those, 7 581 205 patients older than 65 years old met the inclusion criteria. The number of patients with BP diagnosed within 6 months following fluVc enrolled for risk analysis was 4367 (mean [SD] age, 74.19 [5.97] years; 2349 [53.79%] female patients). The incidence rate of BP among all observed fluVc older adults was 57.87 per 100 000 person-years. The IRRs for BP on days 1 through 7, days 8 through 14, and days 15 through 30 were 4.18 (95% CI, 3.82-4.59), 2.73 (95% CI, 2.45-3.05), and 1.67 (95% CI, 1.52-1.84), respectively. However, there was no increase during days 31 through 60 (IRR, 1.06; 95% CI, 0.97-1.16). The postvaccination risk of BP was consistent across all subgroups stratified by sex, age group, and baseline conditions. Conclusions and Relevance The present self-controlled case series indicated that the risk of BP in individuals older than 65 years increased within the first month, especially within the first week, following fluVc. But overall, the adverse event rate of BP was low, and considering the morbidity and mortality of influenza infection, the benefits of fluVc still outweigh the risks.
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Affiliation(s)
- Chin Hu
- Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Hwa Wang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Yu-Chia Chang
- Department of Long Term Care, College of Health and Nursing, National Quemoy University, Kinmen County, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Department of Medical Research & Development, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
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Zhang C, Dong F, Wu Q, Jin J, Li M, Xu X, Peng Z, Chen Y, Ye M, Liu X, Wang L, Zhong Y. Sunshine duration and solar radiation contributed to severe Bell's palsy: An 11-year time series analysis based on a distributed lag non-linear model model. Medicine (Baltimore) 2023; 102:e34400. [PMID: 37478212 PMCID: PMC10662859 DOI: 10.1097/md.0000000000034400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 07/23/2023] Open
Abstract
Although previous studies have suggested that meteorological factors are associated with Bell's palsy, articles on this topic are rare and the results are inconsistent. We aim to reveal the relationship between exposure to different meteorological factors and the onset of severe Bell's palsy (SBP) with daily data. A case-crossover study based on time-series data was applied, and the minimum risk value of each climatic factor was set as the reference value. We fitted a distributed lag non-linear model (DLNM) which applied quasi-Poisson regression to evaluate the exposure-response association and the lag-response association of meteorological factors on the occurrence of SBP. The mode value and per-decile interval value of each meteorological factor were all included in the analysis. Sensitivity analyses were conducted to test the robustness of results. A total of 863 SBP patients (474 males and 389 females) from 7 hospitals in the Shenzhen Futian District were selected from January 2009 to February 2020. The highest relations effect was tested in the cumulative exposure-response result shown as follows; mean temperature at the minimum value 15.3°C with RR of 10.370 (1.557-69.077) over lag 0 to 13; relative humidity at the 30th value 71% with RR of 8.041 (1.016-63.616) over lag 0 to 14; wind speed at the 90th value 31 (0.1 m/s) with RR of 1.286 (1.038-1.593) over lag 0; mean air pressure at the 30th value 1001.4 (pa) with RR of 9.052 (1.039-78.858) over lag 0 to 5; visibility at the 80th value 26.5 (km) with RR of 1.961 (1.005-1.423) over lag 0 to 2; average total cloud cover at the max value 100 (%) with RR 1.787 (1.014-3.148) over lag 0 to 2; sunshine duration at the 10th value 0.1 (h) with RR of 4.772 (1.018-22.361); daily evaporation shows no relationship in the cumulative result; daily average solar radiation at the minimum value 0 (W/m2) with RR of 5.588 (1.184-26.382). There is a relationship between wind speed and the onset of SBP, while mean air pressure, visibility, and average total cloud cover, especially sunshine duration and solar radiation which showed a strong effect, may be associated with severe clinical symptoms of SBP. Mean temperature and relative humidity may affect the course of SBP.
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Affiliation(s)
- Cuiyi Zhang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Fang Dong
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Qi Wu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Jinlan Jin
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Mengtao Li
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Xiaojuan Xu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Zhihua Peng
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Yuanting Chen
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Meixia Ye
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Xingli Liu
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Lijun Wang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
| | - Yinqin Zhong
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, China
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Rafati A, Pasebani Y, Jameie M, Yang Y, Jameie M, Ilkhani S, Amanollahi M, Sakhaei D, Rahimlou M, Kheradmand A. Association of SARS-CoV-2 Vaccination or Infection With Bell Palsy: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2023; 149:493-504. [PMID: 37103913 PMCID: PMC10141297 DOI: 10.1001/jamaoto.2023.0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/13/2023] [Indexed: 04/28/2023]
Abstract
Importance Bell palsy (BP) has been reported as an adverse event following the SARS-CoV-2 vaccination, but neither a causative relationship nor a higher prevalence than in the general population has been established. Objective To compare the incidence of BP in SARS-CoV-2 vaccine recipients vs unvaccinated individuals or placebo recipients. Data Sources A systematic search of MEDLINE (via PubMed), Web of Science, Scopus, Cochrane Library, and Google Scholar from the inception of the COVID-19 report (December 2019) to August 15, 2022. Study Selection Articles reporting BP incidence with SARS-CoV-2 vaccination were included. Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and was conducted with the random- and fixed-effect models using the Mantel-Haenszel method. The quality of the studies was evaluated by the Newcastle-Ottawa Scale. Main Outcomes and Measures The outcomes of interest were to compare BP incidence among (1) SARS-CoV-2 vaccine recipients, (2) nonrecipients in the placebo or unvaccinated cohorts, (3) different types of SARS-CoV-2 vaccines, and (4) SARS-CoV-2-infected vs SARS-CoV-2-vaccinated individuals. Results Fifty studies were included, of which 17 entered the quantitative synthesis. Pooling 4 phase 3 randomized clinical trials showed significantly higher BP in recipients of SARS-CoV-2 vaccines (77 525 vaccine recipients vs 66 682 placebo recipients; odds ratio [OR], 3.00; 95% CI, 1.10-8.18; I2 = 0%). There was, however, no significant increase in BP after administration of the messenger RNA SARS-CoV-2 vaccine in pooling 8 observational studies (13 518 026 doses vs 13 510 701 unvaccinated; OR, 0.70; 95% CI, 0.42-1.16; I2 = 94%). No significant difference was found in BP among 22 978 880 first-dose recipients of the Pfizer/BioNTech vaccine compared with 22 978 880 first-dose recipients of the Oxford/AstraZeneca vaccine (OR, 0.97; 95% CI, 0.82-1.15; I2 = 0%). Bell palsy was significantly more common after SARS-CoV-2 infection (n = 2 822 072) than after SARS-CoV-2 vaccinations (n = 37 912 410) (relative risk, 3.23; 95% CI, 1.57-6.62; I2 = 95%). Conclusions and Relevance This systematic review and meta-analysis suggests a higher incidence of BP among SARS-CoV-2-vaccinated vs placebo groups. The occurrence of BP did not differ significantly between recipients of the Pfizer/BioNTech vs Oxford/AstraZeneca vaccines. SARS-CoV-2 infection posed a significantly greater risk for BP than SARS-CoV-2 vaccination.
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Affiliation(s)
- Ali Rafati
- School of Medicine, Iran University of Medical Sciences, Tehran
| | | | - Melika Jameie
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran
| | - Yuchen Yang
- Department of Neurology and Otolaryngology–Head & Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Mana Jameie
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Ilkhani
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mobina Amanollahi
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran
| | - Delaram Sakhaei
- School of Medicine, Sari Branch, Islamic Azad University, Sari, Iran
| | - Mehran Rahimlou
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amir Kheradmand
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, Maryland
- Department of Neuroscience, Johns Hopkins University, School of Medicine, Baltimore, Maryland
- Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University, School of Medicine, Baltimore, Maryland
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19
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Walker JL, Schultze A, Tazare J, Tamborska A, Singh B, Donegan K, Stowe J, Morton CE, Hulme WJ, Curtis HJ, Williamson EJ, Mehrkar A, Eggo RM, Rentsch CT, Mathur R, Bacon S, Walker AJ, Davy S, Evans D, Inglesby P, Hickman G, MacKenna B, Tomlinson L, Ca Green A, Fisher L, Cockburn J, Parry J, Hester F, Harper S, Bates C, Evans SJ, Solomon T, Andrews NJ, Douglas IJ, Goldacre B, Smeeth L, McDonald HI. Safety of COVID-19 vaccination and acute neurological events: A self-controlled case series in England using the OpenSAFELY platform. Vaccine 2022; 40:4479-4487. [PMID: 35715350 PMCID: PMC9170533 DOI: 10.1016/j.vaccine.2022.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/20/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION We investigated the potential association of COVID-19 vaccination with three acute neurological events: Guillain-Barré syndrome (GBS), transverse myelitis and Bell's palsy. METHODS With the approval of NHS England we analysed primary care data from >17 million patients in England linked to emergency care, hospital admission and mortality records in the OpenSAFELY platform. Separately for each vaccine brand, we used a self-controlled case series design to estimate the incidence rate ratio for each outcome in the period following vaccination (4-42 days for GBS, 4-28 days for transverse myelitis and Bell's palsy) compared to a within-person baseline, using conditional Poisson regression. RESULTS Among 7,783,441 ChAdOx1 vaccinees, there was an increased rate of GBS (N = 517; incidence rate ratio 2·85; 95% CI2·33-3·47) and Bell's palsy (N = 5,350; 1·39; 1·27-1·53) following a first dose of ChAdOx1 vaccine, corresponding to 11.0 additional cases of GBS and 17.9 cases of Bell's palsy per 1 million vaccinees if causal. For GBS this applied to the first, but not the second, dose. There was no clear evidence of an association of ChAdOx1 vaccination with transverse myelitis (N = 199; 1·51; 0·96-2·37). Among 5,729,152 BNT162b2 vaccinees, there was no evidence of any association with GBS (N = 283; 1·09; 0·75-1·57), transverse myelitis (N = 109; 1·62; 0·86-3·03) or Bell's palsy (N = 3,609; 0·89; 0·76-1·03). Among 255,446 mRNA-1273 vaccine recipients there was no evidence of an association with Bell's palsy (N = 78; 0·88, 0·32-2·42). CONCLUSIONS COVID-19 vaccines save lives, but it is important to understand rare adverse events. We observed a short-term increased rate of Guillain-Barré syndrome and Bell's palsy after first dose of ChAdOx1 vaccine. The absolute risk, assuming a causal effect attributable to vaccination, was low.
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Affiliation(s)
- Jemma L Walker
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; NIHR Health Protection Research Unit (HPRU) in Vaccines and Immunisation; UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ, UK
| | - Anna Schultze
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - John Tazare
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Arina Tamborska
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Bhagteshwar Singh
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, UK; Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Katherine Donegan
- Medicines and Healthcare products Regulatory Agency (MHRA), 10 South Colonnade, Canary Wharf, London E14 4PU, UK
| | - Julia Stowe
- UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ, UK
| | - Caroline E Morton
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - William J Hulme
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Helen J Curtis
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Elizabeth J Williamson
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Amir Mehrkar
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Rosalind M Eggo
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Christopher T Rentsch
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rohini Mathur
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sebastian Bacon
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Alex J Walker
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Simon Davy
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - David Evans
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Peter Inglesby
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - George Hickman
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Brian MacKenna
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Laurie Tomlinson
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Amelia Ca Green
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Louis Fisher
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Jonathan Cockburn
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - John Parry
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Frank Hester
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Sam Harper
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Christopher Bates
- OpenSAFELY Collaborative, UK; TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Stephen Jw Evans
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Tom Solomon
- NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, UK; Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Nick J Andrews
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; NIHR Health Protection Research Unit (HPRU) in Vaccines and Immunisation; UK Health Security Agency, 61 Colindale Ave, London NW9 5EQ, UK
| | - Ian J Douglas
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Ben Goldacre
- OpenSAFELY Collaborative, UK; The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Liam Smeeth
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; NIHR Health Protection Research Unit (HPRU) in Vaccines and Immunisation
| | - Helen I McDonald
- OpenSAFELY Collaborative, UK; London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; NIHR Health Protection Research Unit (HPRU) in Vaccines and Immunisation.
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20
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Li X, Raventós B, Roel E, Pistillo A, Martinez-Hernandez E, Delmestri A, Reyes C, Strauss V, Prieto-Alhambra D, Burn E, Duarte-Salles T. Association between covid-19 vaccination, SARS-CoV-2 infection, and risk of immune mediated neurological events: population based cohort and self-controlled case series analysis. BMJ 2022; 376:e068373. [PMID: 35296468 PMCID: PMC8924704 DOI: 10.1136/bmj-2021-068373] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To study the association between covid-19 vaccines, SARS-CoV-2 infection, and risk of immune mediated neurological events. DESIGN Population based historical rate comparison study and self-controlled case series analysis. SETTING Primary care records from the United Kingdom, and primary care records from Spain linked to hospital data. PARTICIPANTS 8 330 497 people who received at least one dose of covid-19 vaccines ChAdOx1 nCoV-19, BNT162b2, mRNA-1273, or Ad.26.COV2.S between the rollout of the vaccination campaigns and end of data availability (UK: 9 May 2021; Spain: 30 June 2021). The study sample also comprised a cohort of 735 870 unvaccinated individuals with a first positive reverse transcription polymerase chain reaction test result for SARS-CoV-2 from 1 September 2020, and 14 330 080 participants from the general population. MAIN OUTCOME MEASURES Outcomes were incidence of Bell's palsy, encephalomyelitis, Guillain-Barré syndrome, and transverse myelitis. Incidence rates were estimated in the 21 days after the first vaccine dose, 90 days after a positive test result for SARS-CoV-2, and between 2017 and 2019 for background rates in the general population cohort. Indirectly standardised incidence ratios were estimated. Adjusted incidence rate ratios were estimated from the self-controlled case series. RESULTS The study included 4 376 535 people who received ChAdOx1 nCoV-19, 3 588 318 who received BNT162b2, 244 913 who received mRNA-1273, and 120 731 who received Ad26.CoV.2; 735 870 people with SARS-CoV-2 infection; and 14 330 080 people from the general population. Overall, post-vaccine rates were consistent with expected (background) rates for Bell's palsy, encephalomyelitis, and Guillain-Barré syndrome. Self-controlled case series was conducted only for Bell's palsy, given limited statistical power, but with no safety signal seen for those vaccinated. Rates were, however, higher than expected after SARS-CoV-2 infection. For example, in the data from the UK, the standardised incidence ratio for Bell's palsy was 1.33 (1.02 to 1.74), for encephalomyelitis was 6.89 (3.82 to 12.44), and for Guillain-Barré syndrome was 3.53 (1.83 to 6.77). Transverse myelitis was rare (<5 events in all vaccinated cohorts) and could not be analysed. CONCLUSIONS No safety signal was observed between covid-19 vaccines and the immune mediated neurological events of Bell's palsy, encephalomyelitis, Guillain-Barré syndrome, and transverse myelitis. An increased risk of Bell's palsy, encephalomyelitis, and Guillain-Barré syndrome was, however, observed for people with SARS-CoV-2 infection.
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Affiliation(s)
- Xintong Li
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, UK
| | - Berta Raventós
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Elena Roel
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Andrea Pistillo
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | | | - Antonella Delmestri
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, UK
| | - Carlen Reyes
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Victoria Strauss
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, UK
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Edward Burn
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford OX3 7LD, UK
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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21
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Walsh PS, Gray JM, Ramgopal S, Lipshaw MJ. Risk of malignancy following emergency department Bell's palsy diagnosis in children. Am J Emerg Med 2022; 53:63-67. [PMID: 34992025 DOI: 10.1016/j.ajem.2021.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To quantify the risk of malignancy following the emergency department (ED) diagnosis of Bell's Palsy (BP) using a large retrospective cohort. STUDY DESIGN We performed a cohort study using the Pediatric Health Information System database. We included all children (6 months - 17 years) from 2011 to 2020 with an ED diagnosis of BP. We excluded children with previous neurologic chronic condition or malignancy diagnosed during or prior to the index visit. Our primary outcome was diagnosis of malignancy within 60 days following the index ED visit. We compared clinical characteristics between children with and without new-onset malignancy. RESULTS Of 12,272 encounters for BP, 41 had a new oncologic diagnosis within 60 days (0.33%, 95% confidence interval [CI]: 0.25-0.45%). Median time to oncologic diagnosis was 22 days. Primary CNS malignancy (59%) and leukemia (17.1%) were the most common diagnoses. Younger children had a higher incidence of new oncologic diagnosis compared with older children. Incidences were 0.68% (95% CI 0.36-1.3%), 0.70% (95% CI 0.38-1.3%), 0.26% (95% CI 0.15-0.47%), and 0.21% (95% CI 0.12-0.37%) for children aged <2 years, 2-5 years, 6-11 years, and 12-17 years respectively. CONCLUSIONS We found a small but potentially clinically significant rate of new-onset oncologic diagnosis within 60 days after BP diagnosis in the ED, especially in children younger than 5 years. Further studies of the diagnostic utility of laboratory testing or neuroimaging and the risk of empiric steroids in children with BP are needed.
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Affiliation(s)
- Patrick S Walsh
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America.
| | - James M Gray
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America
| | - Sriram Ramgopal
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States of America
| | - Matthew J Lipshaw
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States of America
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Abstract
BACKGROUND Vaccinations are a cornerstone of preventative medicine in the USA. However, growing concerns regarding facial nerve palsy following vaccination exist. OBJECTIVE This study aims to assess the occurrence of facial palsy as reported by the Vaccine Adverse Event Reporting System (VAERS) database. METHODS A retrospective analysis of the VAERS database was performed for cases of 'Facial Palsy', 'Bell's Palsy', 'Facial Paralysis' and 'Ramsay Hunt Syndrome' between 2009 and 2018. Subgroup analysis was performed to determine gender, age, history of facial palsy, type of vaccine used, number of days until onset of symptoms and overall facial palsy rate. RESULTS Nine hundred and forty-four entries met our inclusion criteria with 961 vaccine administrations resulting in facial paralysis. Facial palsy following vaccinations was evenly distributed across all age cohorts with two peaks between 60 and 74 years old and between 0 and 14 years old. Most patients were female (N = 526, 55.7%) without a reported history of facial palsy (N = 923, 97.8%). In 2009, reported incidence rate was 0.53%, as compared with 0.23% in 2018. The influenza vaccine had the greatest number of cases (N = 166, 17.3%), followed by the varicella (N = 87, 9.1%) and human papillomavirus vaccines (N = 47, 4.9%). CONCLUSIONS With the SARS-CoV-2 pandemic and recent approvals of the vaccinations, there is growing concern of facial palsy following vaccination. Although it is a known adverse event following vaccination, the likelihood of facial palsy following vaccination is low, with only 0.26% of overall reported cases over a 10-year span.
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Affiliation(s)
- Salma Ahsanuddin
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Wissam Nasser
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Savannah C Roy
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Roman Povolotskiy
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Boris Paskhover
- Department of Otolaryngology—Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
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Wan EYF, Chui CSL, Lai FTT, Chan EWY, Li X, Yan VKC, Gao L, Yu Q, Lam ICH, Chun RKC, Cowling BJ, Fong WC, Lau AYL, Mok VCT, Chan FLF, Lee CK, Chan LST, Lo D, Lau KK, Hung IFN, Leung GM, Wong ICK. Bell's palsy following vaccination with mRNA (BNT162b2) and inactivated (CoronaVac) SARS-CoV-2 vaccines: a case series and nested case-control study. Lancet Infect Dis 2022; 22:64-72. [PMID: 34411532 PMCID: PMC8367195 DOI: 10.1016/s1473-3099(21)00451-5] [Citation(s) in RCA: 127] [Impact Index Per Article: 63.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Bell's palsy is a rare adverse event reported in clinical trials of COVID-19 vaccines. However, to our knowledge no population-based study has assessed the association between the inactivated SARS-CoV-2 vaccines and Bell's palsy. The aim of this study was to evaluate the risk of Bell's palsy after BNT162b2 and CoronaVac vaccination. METHODS In this case series and nested case-control study done in Hong Kong, we assessed the risk of Bell's palsy within 42 days following vaccination with BNT162b2 (Fosun-BioNTech [equivalent to Pfizer-BioNTech]) or CoronaVac (from Sinovac Biotech, Hong Kong) using data from voluntary surveillance reporting with the Hospital Authority, the COVID-19 Vaccine Adverse Event Online Reporting system for all health-care professionals, and the Hospital Authority's territory-wide electronic health records from the Clinical Data Analysis and Reporting System. We described reported cases of Bell's palsy among vaccine recipients (aged 18-110 years for CoronaVac and aged 16-110 years for BNT162b2). We compared the estimated age-standardised incidence of clinically confirmed cases among individuals who had received the CoronaVac or BNT162b2 vaccination (up to 42 days before presentation) with the background incidence in the population. A nested case-control study was also done using conditional logistic regression to estimate the odds ratio (OR) for risk of Bell's palsy and vaccination. Cases and controls were matched (1:4) by age, sex, admission setting, and admission date. FINDINGS Between February 23 and May 4, 2021, 451 939 individuals received the first dose of CoronaVac and 537 205 individuals received the first dose of BNT162b2. 28 clinically confirmed cases of Bell's palsy were reported following CoronaVac and 16 cases were reported following BNT162b2. The age-standardised incidence of clinically confirmed Bell's palsy was 66·9 cases per 100 000 person-years (95% CI 37·2 to 96·6) following CoronaVac vaccination and 42·8 per 100 000 person-years (19·4 to 66·1) for BNT162b2 vaccination. The age-standardised difference for the incidence compared with the background population was 41·5 (95% CI 11·7 to 71·4) for CoronaVac and 17·0 (-6·6 to 40·6) for BNT162b2, equivalent to an additional 4·8 cases per 100 000 people vaccinated for CoronaVac and 2·0 cases per 100 000 people vaccinated for BNT162b2. In the nested case-control analysis, 298 cases were matched to 1181 controls, and the adjusted ORs were 2·385 (95% CI 1·415 to 4·022) for CoronaVac and 1·755 (0·886 to 3·477) for BNT162b2. INTERPRETATION Our findings suggest an overall increased risk of Bell's palsy after CoronaVac vaccination. However, the beneficial and protective effects of the inactivated COVID-19 vaccine far outweigh the risk of this generally self-limiting adverse event. Additional studies are needed in other regions to confirm our findings. FUNDING The Food and Health Bureau of the Government of the Hong Kong Special Administrative Region, China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Eric Yuk Fai Wan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China
| | - Celine Sze Ling Chui
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China
| | - Francisco Tsz Tsun Lai
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China
| | - Esther Wai Yin Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China
| | - Xue Li
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China
| | - Vincent Ka Chun Yan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Le Gao
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Qiuyan Yu
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ivan Chun Hang Lam
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Raccoon Ka Cheong Chun
- Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Benjamin John Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China
| | - Wing Chi Fong
- Department of Medicine, Queen Elizabeth Hospital, Hospital Authority, Hong Kong Special Administrative Region, China; Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Alexander Yuk Lun Lau
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent Chung Tong Mok
- Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China; Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Frank Ling Fung Chan
- Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Cheuk Kwong Lee
- Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China; Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong Special Administrative Region, China
| | - Lot Sze Tao Chan
- Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Dawin Lo
- Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Kui Kai Lau
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ivan Fan Ngai Hung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
| | - Gabriel Matthew Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China
| | - Ian Chi Kei Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong Special Administrative Region, China; Expert Committee on Clinical Events Assessment Following COVID-19 Immunization, Department of Health, The Government of the Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK.
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Patone M, Handunnetthi L, Saatci D, Pan J, Katikireddi SV, Razvi S, Hunt D, Mei XW, Dixon S, Zaccardi F, Khunti K, Watkinson P, Coupland CAC, Doidge J, Harrison DA, Ravanan R, Sheikh A, Robertson C, Hippisley-Cox J. Neurological complications after first dose of COVID-19 vaccines and SARS-CoV-2 infection. Nat Med 2021; 27:2144-2153. [PMID: 34697502 PMCID: PMC8629105 DOI: 10.1038/s41591-021-01556-7] [Citation(s) in RCA: 206] [Impact Index Per Article: 68.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/24/2021] [Indexed: 11/12/2022]
Abstract
Emerging reports of rare neurological complications associated with COVID-19 infection and vaccinations are leading to regulatory, clinical and public health concerns. We undertook a self-controlled case series study to investigate hospital admissions from neurological complications in the 28 days after a first dose of ChAdOx1nCoV-19 (n = 20,417,752) or BNT162b2 (n = 12,134,782), and after a SARS-CoV-2-positive test (n = 2,005,280). There was an increased risk of Guillain-Barré syndrome (incidence rate ratio (IRR), 2.90; 95% confidence interval (CI): 2.15-3.92 at 15-21 days after vaccination) and Bell's palsy (IRR, 1.29; 95% CI: 1.08-1.56 at 15-21 days) with ChAdOx1nCoV-19. There was an increased risk of hemorrhagic stroke (IRR, 1.38; 95% CI: 1.12-1.71 at 15-21 days) with BNT162b2. An independent Scottish cohort provided further support for the association between ChAdOx1nCoV and Guillain-Barré syndrome (IRR, 2.32; 95% CI: 1.08-5.02 at 1-28 days). There was a substantially higher risk of all neurological outcomes in the 28 days after a positive SARS-CoV-2 test including Guillain-Barré syndrome (IRR, 5.25; 95% CI: 3.00-9.18). Overall, we estimated 38 excess cases of Guillain-Barré syndrome per 10 million people receiving ChAdOx1nCoV-19 and 145 excess cases per 10 million people after a positive SARS-CoV-2 test. In summary, although we find an increased risk of neurological complications in those who received COVID-19 vaccines, the risk of these complications is greater following a positive SARS-CoV-2 test.
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Affiliation(s)
- Martina Patone
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Lahiru Handunnetthi
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Defne Saatci
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Saif Razvi
- Institute of Neurological Sciences, Glasgow, UK
| | - David Hunt
- Centre for Clinical Brain Sciences and UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Xue W Mei
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Sharon Dixon
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Peter Watkinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- NIHR Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Carol A C Coupland
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - James Doidge
- Intensive Care National Audit and Research Centre, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - David A Harrison
- Intensive Care National Audit and Research Centre, London, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Aziz Sheikh
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
- Public Health Scotland, Glasgow, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.
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25
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Chang KC, Kong FY. Adverse event reporting and Bell's palsy risk after COVID-19 vaccination. The Lancet Infectious Diseases 2021; 21:1491-1492. [PMID: 34717805 PMCID: PMC8550908 DOI: 10.1016/s1473-3099(21)00621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/20/2021] [Indexed: 11/28/2022]
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26
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Sato K, Mano T, Niimi Y, Toda T, Iwata A, Iwatsubo T. Facial nerve palsy following the administration of COVID-19 mRNA vaccines: analysis of a self-reporting database. Int J Infect Dis 2021; 111:310-312. [PMID: 34492394 PMCID: PMC8418051 DOI: 10.1016/j.ijid.2021.08.071] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/21/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: Facial nerve palsy (or Bell's palsy) has occasionally been reported following the administration of coronavirus disease 2019 (COVID-19) mRNA vaccines (BNT162b2 and mRNA-1273). Our study investigated such cases using a large self-reporting database from the USA (Vaccine Adverse Event Reporting System [VAERS]). Methods: A disproportionality analysis, adjusted for age and sex, was conducted for VAERS reports from individuals who were vaccinated at the age of 18 years or over, between January 2010 and April 2021. Results: The analysis revealed that the adverse events following immunization (AEFI) of facial nerve palsy, after administration of COVID-19 mRNA vaccines, was significantly highly reported, both for BNT162b2 (reporting odds ratio [ROR] 1.84; 95% confidence interval [CI] 1.65–2.06) and mRNA-1273 (ROR 1.54; 95% CI 1.39–1.70). These levels were comparable to that following influenza vaccination reported before the COVID-19 pandemic (ROR 2.04; 95% CI 1.76–2.36). Conclusions: Our pharmacovigilance study results suggest that the incidence of facial nerve palsy as a non-serious AEFI may be lower than, or equivalent to, that for influenza vaccines. This information might be of value in the context of promoting worldwide vaccination, but needs to be validated in future observational studies.
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Affiliation(s)
- Kenichiro Sato
- Department of Neurology, Graduate School of Medicine, University of Tokyo; Department of Neuropathology, Graduate School of Medicine, University of Tokyo; Unit for Early and Exploratory Clinical Development, University of Tokyo Hospital
| | - Tatsuo Mano
- Department of Neurology, Graduate School of Medicine, University of Tokyo
| | - Yoshiki Niimi
- Unit for Early and Exploratory Clinical Development, University of Tokyo Hospital
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, University of Tokyo
| | - Atsushi Iwata
- Department of Neurology, Tokyo Metropolitan Geriatric Medical Center Hospital.
| | - Takeshi Iwatsubo
- Department of Neuropathology, Graduate School of Medicine, University of Tokyo; Unit for Early and Exploratory Clinical Development, University of Tokyo Hospital
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27
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Mutlu A, Kalcioglu MT, Gunduz AY, Bakici B, Yilmaz U, Cag Y. Does the SARS-CoV-2 pandemic really increase the frequency of peripheral facial palsy? Am J Otolaryngol 2021; 42:103032. [PMID: 33857779 PMCID: PMC8025538 DOI: 10.1016/j.amjoto.2021.103032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/04/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Publications about increased number of peripheral facial paralysis in the COVID-19 pandemic emerged in the literature. However, these studies comprised of an estimate rather than a broad analysis of exact numbers. In this study, we planned to investigate whether the pandemic really resulted in an increase in facial paralysis cases admitted to the hospital by evaluating the cases who applied to our hospital due to facial paralysis in the COVID-19 pandemic year and in the previous 4 years. MATERIALS AND METHODS Patients who applied to our hospital due to facial paralysis between March 2016-February 2017 (Group 1), between March 2017-February 2018 (Group 2), between March 2018-February 2019 (Group 3), between March 2019-February 2020 (Group 4), and between March 2020-February 2021 (Group 5) were investigated and detailed data were noted. RESULTS 156, 164, 149, 172 and 157 patients were admitted to the hospital due to peripheral facial paralysis in Group 1, 2, 3, 4, and 5, respectively. Of these patients, 155, 164, 145, 169, and 153 were Bell's palsy, respectively. SARS-CoV-2 RT-PCR test was positive in only 2 of the 153 patients who were diagnosed in the year of the pandemic. CONCLUSIONS This study showed that the number of peripheral facial paralysis detected during the COVID-19 pandemic was similar to previous years. Very few number of positive SARS-CoV-2 RT-PCR test results may have been found incidentally in Bell's palsy patients. Theses stating that SARS-CoV-2 causes peripheral facial paralysis should be supported by laboratory studies and postmortem research.
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Affiliation(s)
- Ahmet Mutlu
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Mahmut Tayyar Kalcioglu
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey.
| | - Ayse Yasemin Gunduz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Burcu Bakici
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Utku Yilmaz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Yasemin Cag
- Istanbul Medeniyet University, Faculty of Medicine, Department of Infectious Disseases and Clinical Microbiology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
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28
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Aslan M, Çiçek MT. Can isolated sudden sensorineural hearing loss (SSNHL) and idiopathic acute facial paralysis (Bell's palsy) be symptoms of COVID-19? Am J Otolaryngol 2021; 42:103129. [PMID: 34214773 PMCID: PMC8239203 DOI: 10.1016/j.amjoto.2021.103129] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The symptoms of COVID-19 at the time of presentation mainly include fever, cough, respiratory distress and myalgia. On the other hand, as neurological symptoms, disruption of taste and smell and cerebrovascular pathologies are well-known, whereas other neurological symptoms and signs are being newly recognized. Sudden-onset sensorineural hearing loss (SSNHL) and idiopathic acute facial paralysis (Bell's palsy) are otologic emergencies that are frequently encountered by otorhinolaryngology specialists. Although there are many articles describing SSNHL and Bell's palsy in the literature, the literature describing their relationship to COVID-19 is limited. In our study, we aimed to present the neuro-otologic relationship of SSNHL and Bell's palsy with COVID-19. MATERIAL AND METHODS The pretreatment real-time oronasopharyngeal PCR tests, COVID-19 symptomatology and COVID-19 infection statuses of patients who presented to our clinic with isolated SSNHL and Bell's palsy between April 2020 and April 2021 were questioned, and the data of the patients were collected. Throughout their treatment, the patients were followed-up in terms of COVID-19 infection. This is a prospective study. Moreover, to observe the change in the incidence, the data of patients visiting between January 2019 and January 2020 were also collected. The data of the patients were statistically analyzed using SPSS. RESULTS The study included a total of 177 patients. The SSNHL group consisted of 91 patients, and the Bell's palsy group consisted of 86 patients. Neither group showed a statistically significant difference in comparison to the year without the pandemic in terms of the patient numbers (incidence), sex, age, morbidity, response to treatment or social habits. There was a statistically significant difference in age only in the Bell's palsy group, but this difference was not medically significant. CONCLUSION As a result of our study, we did not observe a relationship between COVID-19 and cases of SSNHL and Bell's palsy. It is recommended to apply standard otologic treatment to isolated SSNHL and Bell's palsy patients whose association with COVID-19 is not determined.
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Affiliation(s)
- Mehmet Aslan
- Department of Otorhinolaryngology Head and Neck Surgery, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Mehmet Turan Çiçek
- Department of Otorhinolaryngology Head and Neck Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
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Sobue T, Fukuda H, Matsumoto T, Lee B, Ito S, Iwata S. The background occurrence of selected clinical conditions prior to the start of an extensive national vaccination program in Japan. PLoS One 2021; 16:e0256379. [PMID: 34437567 PMCID: PMC8389412 DOI: 10.1371/journal.pone.0256379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/04/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic caused by SARS-CoV-2 has now affected tens of millions of people globally. It is the hope that vaccines against SARS-CoV-2 will deliver a comprehensive solution to this global pandemic; however, this will require extensive national vaccination programs. Ultimately, clinical conditions and even sudden unexplained death will occur around the time of vaccination, thus a distinction needs to be made between events that are causally related to the vaccine or temporally related to vaccination. This study aimed to estimate the background occurrence of 43 clinical conditions in the Japanese population. METHODS A retrospective cohort study was conducted from 2013 to 2019 using data from two large healthcare claims databases (MDV and JMDC) in Japan. The estimated number of new cases and incidence were calculated based on the actual number of new cases identified in the databases. The PubMed and Ichushi-web databases, as well as grey literature such as guidelines and government statistics, were also searched to identify any publications related to incidence of these conditions in Japan. RESULTS AND CONCLUSION The estimates of the number of total cases and incidence were similar for the MDV and JMDC databases for some diseases. In addition, some estimates were similar to those in the scientific literature. For example, from the MDV and JMDC databases, estimates of incidence of confirmed Bell's palsy in 2019 were 41.7 and 47.9 cases per 100,000 population per year, respectively. These estimates were of the same order from the scientific publication. Determining whether clinical conditions occurring around the time of vaccination are causally or only temporally related to vaccination will be critical for public health decision makers as well as for the general public. Comparison of background occurrence at the population level may provide some additional objective evidence for the evaluation of temporality or causality.
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Affiliation(s)
- Tomotaka Sobue
- Division of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University, Fukuoka, Japan
| | - Tetsuya Matsumoto
- Department of Infectious Diseases, International University of Health and Welfare, Narita, Japan
| | - Bennett Lee
- Vaccine Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Shuhei Ito
- Vaccine Medical Affairs, Pfizer Japan Inc., Tokyo, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, National Cancer Center Hospital, Tokyo, Japan
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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Paudel D, Chettri ST, Sah BP, Dahal R, Pyakurel P. Analysis of Prognostic Factors of Bell's Palsy in a Tertiary Care Centre of Eastern Nepal. Kathmandu Univ Med J (KUMJ) 2021; 19:325-329. [PMID: 36254418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Bell's palsy is the most common cause of acute facial peripheral neuropathy commonly encountered in otolaryngology clinics. Studies regarding epidemiology, risk factors, treatment and prognosis of Bell's palsy are sparse in our settings. Objective To analyze the prognostic factors of Bell's palsy in tertiary care Centre of eastern Nepal. Method A retrospective chart review of patients diagnosed with Bell's palsy from 1st January 2005 to 31st December 2018 was done. Records of the patients were obtained from medical record section of BP Koirala Institute of Health Sciences. Result A Total of 208 patients were included for analysis. After six months 72.6% patients had complete recovery. Patients who presented with lower House Brackmann (HB) grade had significantly better complete recovery than those with high grade (89.1% vs 45.6%). The complete recovery was 80.3%, 73.8%, 63.5% and 50% for the patients of more than 30 yrs, 31-45 years, 46-60 years and more than 60 years respectively and the difference was significant (p= 0.012). Alcohol significantly reduced the complete recovery (p= 0.043). Multivariate analysis showed high HB grade score at presentation to be significant predictor of poor prognosis. (p= 0.001 odds ratio 11.262). Conclusion Old age, use of alcohol and the severity of facial nerve palsy at the time of presentation were the bad prognostic factors, severity of the palsy was found to be most significant predictor.
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Affiliation(s)
- D Paudel
- Department of ENT and HNS, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - S T Chettri
- Department of ENT and HNS, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - B P Sah
- Department of ENT and HNS, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - R Dahal
- Department of ENT and HNS, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - P Pyakurel
- Department of Community Medicine and Public Health, BP Koirala Institute of Health Sciences, Dharan, Nepal
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31
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Kopitović A, Katanić F, Kalember S, Simić S, Vico N, Sekulić S. Bell’s Palsy—Retroauricular Pain Threshold. Medicina (B Aires) 2021; 57:medicina57030263. [PMID: 33805591 PMCID: PMC7998624 DOI: 10.3390/medicina57030263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: Non-motor symptoms in the form of increased sensitivity are often associated with the onset of idiopathic Bell’s palsy (IBP). The aims were to determine whether the pain threshold in the retroauricular regions (RAR) in IBP patients and the time of its occurrence is related to IBP severity. Materials and Methods: The study was conducted among 220 respondents (142 IBP patients, 78 healthy subjects (HS)). The degree of IBP was graded using the House–Brackmann and Sunnybrook Grading Scales (II—mild dysfunction, VI—total paralysis), whereas the pain thresholds were measured using the digital pressure algometer. Results: We found no difference in the degree of the pain threshold between the right and left RAR in the HS group. IBP patients belonging to groups II, III, IV, and V had lower pain thresholds in both RARs than HS and IBP patients belonging to group VI. There was no difference in the degree of pain threshold in RAR between the affected and unaffected side in IBP patients. The incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups II and III of IBP patients is noticeably lower and the incidence of retroauricular pain that occurred only after the onset of paralysis is more frequent. Also, we found that the incidence of retroauricular pain that precedes paralysis and ceases after its occurrence in groups V and VI of IBP patients was more frequent. Conclusions: The degree of pain threshold lowering in RAR (bilaterally) is inversely related to the severity of IBP. We suggest that the occurrence of retroauricular pain before the onset of facial weakness is associated with higher severity of IBP while the occurrence after the onset is associated with lower severity of IBP.
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Affiliation(s)
- Aleksandar Kopitović
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000 Novi Sad, Serbia; (A.K.); (S.K.); (S.S.); (N.V.); (S.S.)
- Department of Neurology, Clinical Center of Vojvodina, 1-9 Hajduk Veljkova Street, 21000 Novi Sad, Serbia
| | - Filip Katanić
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000 Novi Sad, Serbia; (A.K.); (S.K.); (S.S.); (N.V.); (S.S.)
- Correspondence: ; Tel.: +38-163-748-2247
| | - Sandro Kalember
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000 Novi Sad, Serbia; (A.K.); (S.K.); (S.S.); (N.V.); (S.S.)
| | - Svetlana Simić
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000 Novi Sad, Serbia; (A.K.); (S.K.); (S.S.); (N.V.); (S.S.)
- Department of Neurology, Clinical Center of Vojvodina, 1-9 Hajduk Veljkova Street, 21000 Novi Sad, Serbia
| | - Nina Vico
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000 Novi Sad, Serbia; (A.K.); (S.K.); (S.S.); (N.V.); (S.S.)
| | - Slobodan Sekulić
- Faculty of Medicine, University of Novi Sad, 3 Hajduk Veljkova Street, 21000 Novi Sad, Serbia; (A.K.); (S.K.); (S.S.); (N.V.); (S.S.)
- Department of Neurology, Clinical Center of Vojvodina, 1-9 Hajduk Veljkova Street, 21000 Novi Sad, Serbia
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Willame C, Dodd C, van der Aa L, Picelli G, Emborg HD, Kahlert J, Gini R, Huerta C, Martín-Merino E, McGee C, de Lusignan S, Roberto G, Villa M, Weibel D, Titievsky L, Sturkenboom MCJM. Incidence Rates of Autoimmune Diseases in European Healthcare Databases: A Contribution of the ADVANCE Project. Drug Saf 2021; 44:383-395. [PMID: 33462778 PMCID: PMC7892524 DOI: 10.1007/s40264-020-01031-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The public-private ADVANCE collaboration developed and tested a system to generate evidence on vaccine benefits and risks using European electronic healthcare databases. In the safety of vaccines, background incidence rates are key to allow proper monitoring and assessment. The goals of this study were to compute age-, sex-, and calendar-year stratified incidence rates of nine autoimmune diseases in seven European healthcare databases from four countries and to assess validity by comparing with published data. METHODS Event rates were calculated for the following outcomes: acute disseminated encephalomyelitis, Bell's palsy, Guillain-Barré syndrome, immune thrombocytopenia purpura, Kawasaki disease, optic neuritis, narcolepsy, systemic lupus erythematosus, and transverse myelitis. Cases were identified by diagnosis codes. Participating organizations/databases originated from Denmark, Italy, Spain, and the UK. The source population comprised all persons registered, with at least 1 year of data prior to the study start, or follow-up from birth. Stratified incidence rates were computed per database over the period 2003 to 2014. RESULTS Between 2003 and 2014, 148,947 incident cases of nine autoimmune diseases were identified. Crude incidence rates were highest for Bell's palsy [23.8/100,000 person-years (PYs), 95% confidence interval (CI) 23.6-24.1] and lowest for Kawasaki disease (0.7/100,000 PYs, 95% CI 0.6-0.7). Specific patterns were observed by sex, age, calendar time, and data sources. Rates were comparable with published estimates. CONCLUSION A range of autoimmune events could be identified in the ADVANCE system. Estimation of rates indicated consistency across selected European healthcare databases, as well as consistency with US published data.
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Affiliation(s)
- Corinne Willame
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
| | - Caitlin Dodd
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Lieke van der Aa
- Sciensano, Rue Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Gino Picelli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (Pedianet), Padua, Italy
| | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Johnny Kahlert
- Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus, Denmark
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | - Consuelo Huerta
- Spanish Agency of Medicines and Medical Devices-AEMPS, Madrid, Spain
| | | | - Chris McGee
- University of Surrey, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London, UK
| | - Simon de Lusignan
- University of Surrey, Oxford, UK
- Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London, UK
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy
| | | | - Daniel Weibel
- VACCINE.GRID, Basel, Switzerland
- Erasmus University Medical Center, PO Box 2014, 3000 CA, Rotterdam, The Netherlands
| | | | - Miriam C J M Sturkenboom
- Julius Global Health, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- VACCINE.GRID, Basel, Switzerland
- P-95, Koning Leopold III laan 1 3001, Heverlee, Leuven, Belgium
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Kim SY, Wee JH, Min C, Yoo DM, Choi HG. Relationship between Bell's Palsy and Previous Statin Use: A Case/Non-Case Study. Int J Environ Res Public Health 2020; 17:ijerph17228408. [PMID: 33202921 PMCID: PMC7696239 DOI: 10.3390/ijerph17228408] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
We intended to determine the relationship between previous statin use and Bell’s palsy in a large study population receiving statins for the past 2 years. The Korean National Health Insurance Service—Health Screening Cohort data from 2002 to 2015 were collected. Participants with Bell’s palsy (n = 3203) were matched with participants without Bell’s palsy (n = 12,812). The number of days of previous statin use for 2 years before the onset of Bell’s palsy was analyzed using conditional logistic regression. Subgroups of age, sex, obesity, smoking, alcohol consumption, total cholesterol, and blood pressure were analyzed for any association between Bell’s palsy and prior statin use. The Bell’s palsy group reported greater statin use than the non-Bell’s palsy group (84.6 (standard deviation, SD = 201.7) vs. 74.4(SD = 189.4), p = 0.009). Previous statin use was associated with Bell’s palsy in the crude model (95% confidence intervals = 1.03–1.19, p = 0.006). However, this relationship disappeared when the possible covariates were adjusted for in model 2. All subgroups showed no increased odds for Bell’s palsy in previous statin users. We did not find an association between Bell’s palsy and previous statin use in this Korean population aged ≥40 years.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13496, Korea;
| | - Jee Hye Wee
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, Anyang 14068, Korea;
| | - Chanyang Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea; (C.M.); (D.-M.Y.)
- Graduate School of Public Health, Seoul National University, Seoul 08826, Korea
| | - Dae-Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea; (C.M.); (D.-M.Y.)
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, Anyang 14068, Korea;
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Korea; (C.M.); (D.-M.Y.)
- Correspondence: ; Tel.: +82-31-380-3849
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Abstract
This study aimed to evaluate the relationship between Bell's palsy and rheumatoid arthritis in a national sample cohort from Korea.Data were collected for individuals ≥20 years old from 2002 to 2013 in the Korean National Health Insurance Service-National Sample Cohort. We extracted data for patients with rheumatoid arthritis (n = 7628) and 1:4-matched controls (n = 30,512) and analyzed the occurrence of Bell's palsy in both groups. Matching was performed based on age, sex, income, and region of residence. Rheumatoid arthritis was diagnosed according to International Classification of Disease-10 (ICD-10) codes (M05-M06) and the prescription of biological agents and/or disease-modifying antirheumatic drugs. Bell's palsy patients were diagnosed according to ICD-10 code H912 and treatment ≥2 times with steroids. Adjusted hazard ratios (HRs) were calculated using stratified Cox proportional hazard models for the Charlson comorbidity index and 95% confidence intervals (CIs). Subgroup analyses based on age and sex were also performed.The rates of Bell's palsy were similar between the rheumatoid arthritis group (0.5% [38/7628]) and the control group, with no significant difference (0.4% [124/30,512], P = .270). The adjusted HR for Bell's palsy was 1.12 (95% CI, 0.78-1.62) in the rheumatoid arthritis group (P = .540). In the subgroup analyses according to age and sex, the relationship between Bell's palsy and rheumatoid arthritis did not reach statistical significance.The risk of Bell's palsy was not increased in patients with rheumatoid arthritis.
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Affiliation(s)
- Sang-Yeon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Jae-Sung Lim
- Department of Neurology, Hallym University College of Medicine, Anyang
| | - Dong Jun Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Bumjung Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Dongtan, South Korea
| | - Hyo Geun Choi
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang
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Abstract
Migraine is thought to be associated with Bell palsy. This study aimed to investigate the risk of Bell palsy in migraine patients.The Korean National Health Insurance Service-National Sample Cohort was collected from 2002 to 2013. A total of 45,164 migraine patients were matched for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia and compared with 180,656 controls. The migraine group included participants diagnosed with migraine [International Classification of Disease (ICD)-10: G43] who underwent treatment more than once. Participants with Bell palsy were included on the basis of the ICD-10 (G510) and treatment with steroids. A history of hypertension, diabetes, and dyslipidemia was determined using ICD-10 codes. Crude (simple) and adjusted hazard ratios (HRs) of Bell palsy in migraine patients were analyzed using the Cox proportional hazards model. Subgroup analyses were conducted based on age and sex.Bell palsy occurred in 0.6% (262/44,902) of the migraine group and 0.5% (903/179,753) of the control group. The adjusted HR of Bell palsy was 1.16 in the migraine group compared with the control group [95% confidence interval (95% CI) = 1.01-1.33, P = .34]. Among age-related subgroups, participants ≥30 and <60 years old in the migraine subgroup demonstrated a 1.28-times higher risk of Bell palsy than the control group (95% CI = 1.05-1.57, P = .014).Migraine increased the risk of Bell palsy in the total population. Among age subgroups, migraine patients ≥30 and <60 years old had an increased risk of Bell palsy.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam
| | - Chang-Ho Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam
| | - Jae-Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang
| | - Il Gyu Kong
- Department of Statistics, Hallym University, Chuncheon
| | - Songyong Sim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Geun Choi
- Department of Statistics, Hallym University, Chuncheon
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Cooper L, Branagan-Harris M, Tuson R, Nduka C. Lyme disease and Bell's palsy: an epidemiological study of diagnosis and risk in England. Br J Gen Pract 2017; 67:e329-e335. [PMID: 28396367 PMCID: PMC5409434 DOI: 10.3399/bjgp17x690497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/11/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Lyme disease is caused by a tick-borne spirochaete of the Borrelia species. It is associated with facial palsy, is increasingly common in England, and may be misdiagnosed as Bell's palsy. AIM To produce an accurate map of Lyme disease diagnosis in England and to identify patients at risk of developing associated facial nerve palsy, to enable prevention, early diagnosis, and effective treatment. DESIGN AND SETTING Hospital episode statistics (HES) data in England from the Health and Social Care Information Centre were interrogated from April 2011 to March 2015 for International Classification of Diseases 10th revision (ICD-10) codes A69.2 (Lyme disease) and G51.0 (Bell's palsy) in isolation, and as a combination. METHOD Patients' age, sex, postcode, month of diagnosis, and socioeconomic groups as defined according to the English Indices of Deprivation (2004) were also collected. RESULTS Lyme disease hospital diagnosis increased by 42% per year from 2011 to 2015 in England. Higher incidence areas, largely rural, were mapped. A trend towards socioeconomic privilege and the months of July to September was observed. Facial palsy in combination with Lyme disease is also increasing, particularly in younger patients, with a mean age of 41.7 years, compared with 59.6 years for Bell's palsy and 45.9 years for Lyme disease (P = 0.05, analysis of variance [ANOVA]). CONCLUSION Healthcare practitioners should have a high index of suspicion for Lyme disease following travel in the areas shown, particularly in the summer months. The authors suggest that patients presenting with facial palsy should be tested for Lyme disease.
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Affiliation(s)
- Lilli Cooper
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, West Sussex
| | | | - Richard Tuson
- Health analytics and NHS policy expert, Device Access UK Ltd, Michelmersh, Hampshire
| | - Charles Nduka
- Plastic Surgery Department, Queen Victoria Hospital, East Grinstead, West Sussex
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rogalska E, Skowronek-Bała B, Świerczyńska A, Kaciński M. [Bell's palsy in malopolska's children in 2010-2014 years]. Przegl Lek 2016; 73:170-173. [PMID: 27349048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Peripheral facial nerve palsy (Bell' palsy, BP) is a not rare diseases in children, being the most common acquired mononeuropathy. AIM The authors of this study wanted to determine whether the occurrence and course of paralysis changed in the past 5 years (2010-2014). MATERIALS AND METHODS The study involved Lesser Poland region, where the majority of children with paralysis are hospitalized at the Pediatric Neurology Department of University Children's Hospital in Krakow. These children in subsequent years were admitted to our department without any limitations. A review of clinical documentation of 125 patients, in terms of demographics, the coexistence of other diseases, seasonality, the degree of paralysis, location of paralysis, the prevalence of the recurrence was made. Changes in the structure of the nerve VII in MRI and CT, pharmacological treatment, applied rehabilitation, the degree of improvement and time of hospitalization were analyzed. RESULTS Similar distribution of occurrence and gender of children with BP in Lesser Poland region within 5 years were observed. The predominance of the girls resulted from demographic composition of the population. BP occurred most frequently in summer and winter. In more than half of children BP occurred in the course of acute systemic infection or craniofacial infection and in 5/125 BP followed head injury. Children with infections required antibiotic therapy. Left-sided paralysis was found in the majority of children and almost half of patients needed protection of the cornea of the eye (significant degree). In 12% of children structural changes within the facial nerve were found. In these children antiviral treatment was used and hospitalization time was more than 20 days while in the majority of children hospitalization lasted 15 days. In 8 (6.4%) children with recurrent BP kinezytherapy, electrical stimulation and laser therapy were applied. Steroid therapy was not used. Only 7/125 chil. dren had mild impairment of the eye closing at the discharge and the others received nearly complete recovery. CONCLUSIONS Inflammatory etiology is the most common in children with BP. BP occurs more often in the summer and winter. Severity of paralysis was significant in more than half of hospitalized children. Children with structural changes within the nerve VII required longer hospitalization and comprehensive treatment.
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Abstract
We present a retrospective, observational study of all patients diagnosed with Bells' palsy (BP) at the Central District of Clalit Health Services from 2003 through to 2012. BP is associated with several complications. We evaluated clinical characteristics including the number of patient visits to general physicians (GP), otolaryngologists, ophthalmologists and neurologists, medications prescribed in the acute phase of BP (steroids and antiviral agents), and the ophthalmic diagnoses. A total of 4463 patients with the diagnosis of BP were included. The incidence per 100,000/year was 87.0, and it increased with age. Patients had significantly more visits to all specialists at 6 months after the BP event. Steroid treatment was prescribed to 50.4% of the patients and antiviral agents to 65.5%. Both treatments were associated with older patient age and female sex. The rate of post BP lagophthalmos and keratitis was 3.45% and 0.63% at 1-3 months, respectively, and both were more likely to develop in older patients. Steroid and/or antiviral treatments were not associated with a decrease in ophthalmic complications. BP may cause ophthalmic complications at a low rate, which are associated with older age. Steroids and antiviral agents appeared to have no effect on ophthalmic complications.
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Affiliation(s)
- Arie Y Nemet
- Department of Ophthalmology, Meir Medical Center, 59 Tchernichovsky Street, Kfar Sava 44281, Israel.
| | - Shlomo Vinker
- Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Achour I, Chakroun A, Ayedi S, Ben Rhaiem Z, Mnejja M, Charfeddine I, Hammami B, Ghorbel A. [Idiopathic facial paralysis in children]. Arch Pediatr 2015; 22:476-9. [PMID: 25817175 DOI: 10.1016/j.arcped.2015.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 01/20/2015] [Accepted: 02/17/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Idiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment. PATIENTS AND METHODS A retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012. RESULTS A total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks. DISCUSSION Children with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified. CONCLUSION Randomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis.
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Affiliation(s)
- I Achour
- Service ORL et chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie.
| | - A Chakroun
- Service ORL et chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - S Ayedi
- Service ORL et chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - Z Ben Rhaiem
- Service ORL et chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - M Mnejja
- Service ORL et chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - I Charfeddine
- Service ORL et chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - B Hammami
- Service ORL et chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
| | - A Ghorbel
- Service ORL et chirurgie cervico-faciale, CHU Habib Bourguiba, 3029 Sfax, Tunisie
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Abstract
Concern about a possible increased risk of Bell's palsy after parenteral inactivated influenza vaccine was raised following the publication in 2004 of a Swiss study in which there was an increased risk following the nasal inactivated formulation of the vaccine. When data from passive reporting systems in the United States and the United Kingdom were examined there was some evidence of increased reporting following the parenteral vaccine. A large population based study using the General Practice Research Database (GPRD) was therefore performed to test the hypothesis that there was an increased risk of Bell's palsy in the three months following parenteral inactivated influenza vaccine. The risk was also assessed for the same period following pneumococcal vaccine and was stratified into three age groups (<45, 45-64 and 65+ years). Relative incidence (RI) estimates were calculated using the self-controlled case-series method and showed no evidence of an increased risk in the three months following parenteral inactivated influenza vaccine RI 0.92 (95% confidence interval 0.78-1.08). There was also no evidence of an increased risk in any age group or following pneumococcal vaccine. A significant increase was seen on the day of vaccination (day 0) probably due to opportunistic recording of cases.
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Affiliation(s)
- Julia Stowe
- Immunisation Department, Health Protection Agency Centre for Infections, London, UK
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Affiliation(s)
- Shih-Han Hung
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
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Cirpaciu D, Goanta CM, Cirpaciu MD. Recurrences of Bell's palsy. J Med Life 2014; 7 Spec No. 3:68-77. [PMID: 25870699 PMCID: PMC4391412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Bell's palsy in known as the most common cause of facial paralysis, determined by the acute onset of lower motor neuron weakness of the facial nerve with no detectable cause. With a lifetime risk of 1 in 60 and an annual incidence of 11-40/100,000 population, the condition resolves completely in around 71% of the untreated cases. Clinical trials performed for Bell's palsy have reported some recurrences, ipsilateral or contralateral to the side affected in the primary episode of facial palsy. Only few data are found in the literature. Melkersson-Rosenthal is a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue (lingua plicata), orofacial edema. PURPOSE We attempted to analyze some clinical and epidemiologic aspects of recurrent idiopathic palsy, and to develop relevant correlations between the existing data in literature and those obtained in this study. METHODS & MATERIALS This is a retrospective study carried out on a 10-years period for adults and a five-year period for children. RESULTS A number of 185 patients aged between 4 and 70 years old were analyzed. 136 of them were adults and 49 were children. 22 of 185 patients with Bell's palsy (12%) had a recurrent partial or complete facial paralysis with one to six episodes of palsy. From this group of 22 cases, 5 patients were diagnosed with Melkersson-Rosenthal syndrome. The patients' age was between 4 and 70 years old, with a medium age of 27,6 years. In the group studied, fifteen patients, meaning 68%, were women and seven were men. The majority of patients in our group with more than two facial palsy episodes had at least one episode on the contralateral side. CONCLUSIONS Our study found a significant incidence of recurrences of idiopathic facial palsy. Recurrent idiopathic facial palsy and Melkersson-Rosenthal syndrome is diagnosed more often in young females. Recurrence is more likely to occur in the first two years from the onset, which leads to the conclusion that we should have a follow up of patients diagnosed with Bell's palsy for at least two years from the onset, especially in children' case. The frequency of recurrent facial palsy in children was similar to that in adults. Recurrent idiopathic facial palsy is not known enough and needs further controlled studies.
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Affiliation(s)
- D Cirpaciu
- Alexandria County Emergency Hospital, Romania
| | - C M Goanta
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - M D Cirpaciu
- "Acad. Vasile Candea" Army's Center for Cardiovascular Diseases, Romania
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Each year in the UK around 1 in 5,000 people develop Bell's palsy-idiopathic unilateral lower motor neurone facial weakness of rapid onset. Although about 70% recover spontaneously, the remaining 30% are at risk of complications;(1) 13% have residual slight weakness and about 16% have persistent moderate to severe weakness if not treated.(2) As we have discussed in two previous articles there has been longstanding controversy about the best form of treatment.(2,3) In 2006 we concluded that published trials on the efficacy of drug treatments have been poor and no firm conclusions can be drawn about the benefit of any single drug;(2) in 2008 we noted that evidence suggests oral prednisolone started within 72 hours of symptom onset makes recovery more likely and that there was little good evidence that an antiviral drug helps.(3) The place of antivirals in the management of Bell's palsy remains a controversial issue. In this article we review the evidence for antiviral therapy alone or in conjunction with corticosteroid treatment.
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Bardage C, Persson I, Ortqvist A, Bergman U, Ludvigsson JF, Granath F. Neurological and autoimmune disorders after vaccination against pandemic influenza A (H1N1) with a monovalent adjuvanted vaccine: population based cohort study in Stockholm, Sweden. BMJ 2011; 343:d5956. [PMID: 21994316 PMCID: PMC3192001 DOI: 10.1136/bmj.d5956] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the risk of neurological and autoimmune disorders of special interest in people vaccinated against pandemic influenza A (H1N1) with Pandemrix (GlaxoSmithKline, Middlesex, UK) compared with unvaccinated people over 8-10 months. DESIGN Retrospective cohort study linking individualised data on pandemic vaccinations to an inpatient and specialist database on healthcare utilisation in Stockholm county for follow-up during and after the pandemic period. SETTING Stockholm county, Sweden. Population All people registered in Stockholm county on 1 October 2009 and who had lived in this region since 1 January 1998; 1,024,019 were vaccinated against H1N1 and 921,005 remained unvaccinated. MAIN OUTCOME MEASURES Neurological and autoimmune diagnoses according to the European Medicines Agency strategy for monitoring of adverse events of special interest defined using ICD-10 codes for Guillain-Barré syndrome, Bell's palsy, multiple sclerosis, polyneuropathy, anaesthesia or hypoaesthesia, paraesthesia, narcolepsy (added), and autoimmune conditions such as rheumatoid arthritis, inflammatory bowel disease, and type 1 diabetes; and short term mortality according to vaccination status. RESULTS Excess risks among vaccinated compared with unvaccinated people were of low magnitude for Bell's palsy (hazard ratio 1.25, 95% confidence interval 1.06 to 1.48) and paraesthesia (1.11, 1.00 to 1.23) after adjustment for age, sex, socioeconomic status, and healthcare utilisation. Risks for Guillain-Barré syndrome, multiple sclerosis, type 1 diabetes, and rheumatoid arthritis remained unchanged. The risks of paraesthesia and inflammatory bowel disease among those vaccinated in the early phase (within 45 days from 1 October 2009) of the vaccination campaign were significantly increased; the risk being increased within the first six weeks after vaccination. Those vaccinated in the early phase were at a slightly reduced risk of death than those who were unvaccinated (0.94, 0.91 to 0.98), whereas those vaccinated in the late phase had an overall reduced mortality (0.68, 0.64 to 0.71). These associations could be real or explained, partly or entirely, by residual confounding. CONCLUSIONS Results for the safety of Pandemrix over 8-10 months of follow-up were reassuring -notably, no change in the risk for Guillain-Barré syndrome, multiple sclerosis, type 1 diabetes, or rheumatoid arthritis. Relative risks were significantly increased for Bell's palsy, paraesthesia, and inflammatory bowel disease after vaccination, predominantly in the early phase of the vaccination campaign. Small numbers of children and adolescents with narcolepsy precluded any meaningful conclusions.
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Affiliation(s)
- Carola Bardage
- Medical Products Agency, PO Box 26, SE-751 03 Uppsala, Sweden
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Sánchez-Chapul L, Reyes-Cadena S, Andrade-Cabrera JL, Carrillo-Soto IA, León-Hernández SR, Paniagua-Pérez R, Olivera-Díaz H, Baños-Mendoza T, Flores-Mondragón G, Hernández-Campos NA. Bell's palsy. A prospective, longitudinal, descriptive, and observational analysis of prognosis factors for recovery in Mexican patients. Rev Invest Clin 2011; 63:361-369. [PMID: 22364035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine the prognosis factors in Mexican patients with Bell's palsy. DESIGN We designed a prospective, longitudinal, descriptive, and observational analysis. Two hundred and fifty one patients diagnosed with Bell's palsy at the National Institute of Rehabilitation were included. We studied the sociodemographic characteristics, seasonal occurrence, sidedness, symptoms, and therapeutic options to determine the prognostic factors for their recovery. RESULTS Thirty-nine percent of patients had a complete recovery and 41.5% had an incomplete recovery. Marital status, gender, etiology, symptoms, sidedness, House-Brackmann grade, and treatments did not represent significant prognostic factors for recovery. Age > 40 years (OR = 2.4, IC 95% 1.3-4.3, p = 0.002) and lack of physical therapy (OR = 6.4, IC 95% 1.4-29.6, p = 0.006) were significant prognostic factors for incomplete recovery. Familial palsy resulted to be a protective prognostic factor against an incomplete recovery (OR = 0.54, IC 95% 0.28-1.01, p = 0.039). This protection factor was only significant in female patients (OR = 0.41, p = 0.22) but not in male patients (OR = 1.0, p = 0.61). CONCLUSIONS The proportion of cases with incomplete recovery was high. The age > 40 years and lack of physical therapy were the only significant prognostic factors for an incomplete recovery.
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Affiliation(s)
- Laura Sánchez-Chapul
- Laboratorio de Bioquímica Muscular, Instituto Nacional de Rehabilitación, México, DF.
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Abstract
CONCLUSIONS Recurrence of vestibular neuritis (VN) is a rare event in long-term follow-up. The incidence of benign paroxysmal positional vertigo (BPPV) in VN patients represents a quite common outcome. To our knowledge, this study represents the only long-term longitudinal study on recurrence of VN and incidence of secondary BPPV in VN. OBJECTIVES To study a large number of VN patients longitudinally to identify the recurrence rate of VN and incidence of BPPV, other peripheral vestibular disorders, sudden hearing loss or Bell's palsy. METHODS This prospective cohort study assessed a VN patient-based clinic population. All patients received a complete bedside clinical examination and caloric irrigation. RESULTS Long-term (range 4-6 years, mean 4.9 years) longitudinal follow-up examination of 51 VN patients demonstrated a low recurrence rate (1/51 patients, 2.0%). With recurrence, VN affected the same ear after 6 months and caused less severe symptoms. BPPV appears to be more frequent (5/51 patients, 9.8%) in VN patients than in the general population, consistently affecting the posterior canal of the same ear. BPPV occurrence after VN predominantly affects VN patients who did not fully recover from the disease. Moreover, BPPV after VN appears to be more difficult to treat than idiopathic BPPV.
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Affiliation(s)
- Marco Mandalà
- Department of Human Pathology and Oncology, University of Siena, School of Medicine, Siena, Italy.
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Musani MA, Farooqui AN, Usman A, Atif S, Afaq S, Khambaty Y, Ahmed L. Association of herpes simplex virus infection and Bell's palsy. J PAK MED ASSOC 2009; 59:823-825. [PMID: 20201172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To determine the association of the Herpes Simplex virus Type-1 infection and Bell's palsy in patients treated at the outpatient department of a tertiary care center. METHODS A prospective, observational study was carried out at the outpatient department of Medical and ENT units of Abbasi Shaheed Hospital, Karachi. Fifty patients were enrolled in the study with their informed and written consent, between 2006-2007. All were >12 years of age. They were diagnosed as having Bell's palsy and were investigated for serologic evidence of Herpes simplex virus (HSV). The IgG and IgM antibodies for HSV were identified in the blood samples at the Aga Khan University hospitals laboratory. RESULT Of the 50 patients enrolled, 35 (70%) patients were IgG/IgM positive for the HSV stressing the etiological association of HSV with Bell's palsy. CONCLUSION The study suggests that a relationship exists between HSV infection and Bell's palsy. The information might prove helpful in hastening the recovery by modifying management guidelines in view of the results of this study.
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Tsai HS, Chang LY, Lu CY, Lee PI, Chen JM, Lee CY, Huang LM. Epidemiology and treatment of Bell's palsy in children in northern Taiwan. J Microbiol Immunol Infect 2009; 42:351-356. [PMID: 19949760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND PURPOSE Bell's palsy is not uncommon in children. This study was performed to evaluate the epidemiology of Bell's palsy in the northern Taiwanese pediatric population, and the effectiveness of corticosteroid treatment. METHODS The medical records of pediatric patients with a primary diagnosis of facial palsy from April 2002 through March 2007 were reviewed. Patients with secondary facial palsy were excluded from the analysis. RESULTS 289 episodes of facial palsy were identified and the clinical findings of 134 episodes among 132 patients were assessed. The median +/- standard deviation age was 9.9 +/- 4.9 years, and 58.2% of patients were girls. Children were more likely to have episodes of Bell's palsy during the cold season, with a peak in January. The left (67 episodes; 50.0%) and right (64 episodes; 47.8%) facial nerves were involved with similar frequency. Common symptoms were postauricular pain (11.2%) and facial hypoesthesia (9.0%). Of 51 episodes of Bell's palsy with complete follow-up, corticosteroids were given for 44 episodes. Thirty eight patients (86.4%) given corticosteroids had complete recovery and 4 patients (57.1%) recovered without corticosteroids. Rates of complete recovery did not differ significantly between the 2 groups (p = 0.08). There were no significant differences in the recovery rate between early (< or = 3 days) and late (4-7 days) administration. CONCLUSIONS In northern Taiwan, childhood Bell's palsy peaks from January through March. The majority of children with Bell's palsy recovered completely. There was no significant effect of corticosteroid treatment for children with Bell's palsy.
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Affiliation(s)
- Han Sheng Tsai
- Department of Pediatrics, Department of Infectious Diseases, National Taiwan University Hospital, Taipei 100, Taiwan
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