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Prognostic factors of Bell’s palsy: prospective patient collected observational study

  • Otology
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Abstract

The purpose of this study was to evaluate various parameters potentially influencing poor prognosis in Bell’s palsy and to assess the predictive value for Bell’s palsy. A single-center prospective patient collected observation and validation study was conducted. To evaluate the correlation between patient characteristics and poor prognosis, we performed univariate and multivariate analyzes of age, gender, side of palsy, diabetes mellitus, hypertension, and facial grading score 1 week after onset. To evaluate the accuracy of the facial grading score, we prepared a receiver operating characteristic (ROC) curve and calculated the area under the ROC curve (AUROC). We also calculated sensitivity, specificity, positive/negative likelihood ratio, and positive/negative predictive value. We included Bell’s palsy patients who attended Ehime University Hospital within 1 week after onset between 1977 and 2011. We excluded patients who were less than 15 years old and lost-to-follow-up within 6 months. The main outcome was defined as non-recovery at 6 months after onset. In total, 679 adults with Bell’s palsy were included. The facial grading score at 1 week showed a correlation with non-recovery in the multivariate analysis, although age, gender, side of palsy, diabetes mellitus, and hypertension did not. The AUROC of the facial grading score was 0.793. The Y-system score at 1 week moderate accurately predicted non-recovery at 6 months in Bell’s palsy.

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References

  1. Hauser WA, Karnes WE, Annis J, Kurland LT (1971) Incidence and prognosis of Bell’s palsy in the population of Rochester, Minnesota. Mayo Clin Proc Mayo Clin 46(4):258–264

    CAS  Google Scholar 

  2. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N (1996) Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med 124(1 Pt 1):27–30

    Article  CAS  PubMed  Google Scholar 

  3. Peitersen E (2002) Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 549:4–30

    Article  PubMed  Google Scholar 

  4. Salinas RA, Alvarez G, Daly F, Ferreira J (2010) Corticosteroids for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev (3):CD001942. doi:10.1002/14651858.CD001942.pub4

  5. van der Veen EL, Rovers MM, de Ru JA, van der Heijden GJ (2012) A small effect of adding antiviral agents in treating patients with severe Bell palsy. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 146(3):353–357. doi:10.1177/0194599811432537

    Article  Google Scholar 

  6. Marsk E, Hammarstedt L, Berg T, Engstrom M, Jonsson L, Hultcrantz M (2010) Early deterioration in Bell’s palsy: prognosis and effect of prednisolone. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 31(9):1503–1507. doi:10.1097/MAO.0b013e3181f2f21f

    Google Scholar 

  7. Takemoto N, Horii A, Sakata Y, Inohara H (2011) Prognostic factors of peripheral facial palsy: multivariate analysis followed by receiver operating characteristic and Kaplan-Meier analyses. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 32(6):1031–1036. doi:10.1097/MAO.0b013e31822558de

    Article  Google Scholar 

  8. Mantsopoulos K, Psillas G, Psychogios G, Brase C, Iro H, Constantinidis J (2011) Predicting the long-term outcome after idiopathic facial nerve paralysis. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 32(5):848–851. doi:10.1097/MAO.0b013e31821da2c6

    Article  Google Scholar 

  9. Tojima H, Aoyagi M, Inamura H, Koike Y (1994) Clinical advantages of electroneurography in patients with Bell’s palsy within two weeks after onset. Acta Otolaryngol Suppl 511:147–149

    Article  CAS  PubMed  Google Scholar 

  10. Yeo SW, Lee DH, Jun BC, Chang KH, Park YS (2007) Analysis of prognostic factors in Bell’s palsy and Ramsay Hunt syndrome. Auris Nasus Larynx 34(2):159–164. doi:10.1016/j.anl.2006.09.005

    Article  PubMed  Google Scholar 

  11. Ushio M, Kondo K, Takeuchi N, Tojima H, Yamaguchi T, Kaga K (2008) Prediction of the prognosis of Bell’s palsy using multivariate analyses. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 29(1):69–72. doi:10.1097/mao.0b013e31815c2aa0

    Article  Google Scholar 

  12. Marsk E, Bylund N, Jonsson L, Hammarstedt L, Engstrom M, Hadziosmanovic N, Berg T, Hultcrantz M (2012) Prediction of nonrecovery in Bell’s palsy using Sunnybrook grading. Laryngoscope 122(4):901–906. doi:10.1002/lary.23210

    Article  PubMed  Google Scholar 

  13. Yanagihara N (1977) Grading of facial palsy. Facial Nerve Surgery. Aesculpius, Birmingham, AL

    Google Scholar 

  14. Berg T, Jonsson L, Engstrom M (2004) Agreement between the Sunnybrook, House-Brackmann, and Yanagihara facial nerve grading systems in Bell’s palsy. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 25(6):1020–1026

    Article  Google Scholar 

  15. Esaki S, Yamano K, Kiguchi J, Katsumi S, Keceli S, Okamoto H, Goshima F, Kimura H, Nishiyama Y, Murakami S (2012) Diabetic mice show an aggravated course of herpes-simplex virus-induced facial nerve paralysis. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc Eur Acad Otol Neurotol 33(8):1452–1457. doi:10.1097/MAO.0b013e318268d54d

    Article  Google Scholar 

  16. Satoh Y, Kanzaki J, Yoshihara S (2000) A comparison and conversion table of ‘the House-Brackmann facial nerve grading system’ and ‘the Yanagihara grading system’. Auris Nasus Larynx 27(3):207–212

    Article  CAS  PubMed  Google Scholar 

  17. Murakami S (2011) Treatment of peripheral facial paralysis in acute phase. In: Japan Society of Facial Nerve Research (ed) Guideline for facial paralysis—Bell’s palsy and Hunt syndrome, Kanehara shuppan, Japan, pp 55–59

  18. Berg T, Marsk E, Engstrom M, Hultcrantz M, Hadziosmanovic N, Jonsson L (2009) The effect of study design and analysis methods on recovery rates in Bell’s palsy. Laryngoscope 119(10):2046–2050. doi:10.1002/lary.20626

    Article  PubMed  Google Scholar 

  19. Lockhart P, Daly F, Pitkethly M, Comerford N, Sullivan F (2009) Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev (4):CD001869. doi:10.1002/14651858.CD001869.pub4

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The authors declare that they have no conflict of interest.

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Correspondence to Takashi Fujiwara.

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Fujiwara, T., Hato, N., Gyo, K. et al. Prognostic factors of Bell’s palsy: prospective patient collected observational study. Eur Arch Otorhinolaryngol 271, 1891–1895 (2014). https://doi.org/10.1007/s00405-013-2676-9

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  • DOI: https://doi.org/10.1007/s00405-013-2676-9

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