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Comparison of oral versus intravenous steroid in the management of Bell’s palsy: a systematic review and meta-analysis of randomized clinical trials

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Abstract

Background

Bell’s palsy is a condition affecting cranial nerve VII that results in acute peripheral unilateral facial weakness or paralysis of unclear etiology. Corticosteroids are the primary therapy choice, because they improve outcomes. According to a recent study, prednisolone effectively treats Bell’s palsy in the short and long term. This study aimed to assess the effectiveness and safety of Single-Dose Intravenous Methylprednisolone to Oral Prednisolone in treating Bell’s palsy patients.

Methods

PRISMA statement guidelines were used to design and conduct this systemic review. MEDLINE, Cochrane Library, and EMBASE databases were used in our search. We conducted the database search in November 2022.

Results

Thirty-three publications were reviewed as a result of the literature review. Three studies were included in the meta-analysis after applying our criteria. 317 Bell’s palsy patients were included in our study. Regarding complete recovery to grade 1 in 1 month, IV methylprednisolone was higher than oral prednisolone; (log OR = 0.52, 95% CI [0.08, 0.97], P = 0.022). However, at 3 months, the two groups had no significant difference. Patients with grade 4 Bell’s palsy were more likely to fully recover to grade 1 in 1 month with IV methylprednisolone than with oral prednisolone (log OR = 0.73, 95% CI [0.19, 1.26], P = 0.008), but not for patients with grade 3 or grade 2 Bell’s palsy.

Conclusion

This study shows evidence that patients with Bell’s palsy can fully recover to grade 1 in 1 month when IV methylprednisolone is used instead of oral prednisolone. At 3 months, however, there was no discernible difference between the two treatments. Within 3 days of the onset of symptoms, IV methylprednisolone treatment can be started, which may help patients recover fully to grade 1 in 1 month. However, administering IV methylprednisolone may not always have long-term advantages compared to oral prednisolone.

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Acknowledgements

The authors would like to thank and appreciate the working of Dr.Omar in helping in the meta-analysis.

Author information

Authors and Affiliations

  1. Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

    Shahad Hani Abdu

  2. Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia

    Abdulrahman Hameed Alsubhi, Anas Alzahrani & Abdulrahman Alshehri

  3. King Abdulaziz University Hospital, Jeddah, Saudi Arabia

    Nada Al Taylouni

  4. Department of Otolaryngology Head-Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

    Almoaidbellah Rammal

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  1. Shahad Hani Abdu
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  2. Abdulrahman Hameed Alsubhi
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Correspondence to Almoaidbellah Rammal.

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Abdu, S.H., Alsubhi, A.H., Alzahrani, A. et al. Comparison of oral versus intravenous steroid in the management of Bell’s palsy: a systematic review and meta-analysis of randomized clinical trials. Eur Arch Otorhinolaryngol 281, 1095–1104 (2024). https://doi.org/10.1007/s00405-023-08288-z

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