Bell’s Palsy: Symptoms Preceding and Accompanying the Facial Paresis

This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell’s palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy.

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COMPLETE MANAGEMENT OF ARDITA (BELL’S PALSY) AS PER AYURVEDA CHIKITSA SUTRA – A CASE REPORT

November 2020 - International Ayurvedic Medical Journal ◽

10.46607/iamj2209032021 ◽

2021 ◽

Vol 09 (3) ◽

pp. 650-656

Author(s):

Ram Lakhan Meena ◽

Santoshkumar Bhatted ◽

Nilam Meena

Keyword(s):

Case Report ◽

Adverse Effects ◽

Facial Nerve ◽

Present Report ◽

Complete Recovery ◽

Bell’S Palsy ◽

Bell's Palsy ◽

Contemporary Science ◽

The Face ◽

Grading Scale

Bell’s palsy, also known as acute idiopathic lower motor neuron facial paralysis, is characterized by sud-den onset paralysis or weakness of the muscles to one side of the face controlled by the facial nerve. In contemporary science, administration of steroids is the treatment of choice for complete facial palsy. Cer-tain Panchakarma procedures and internal Ayurvedic medicines have been proved to be beneficial in the management of Ardita vata. The present report deals with a case of 62-year-old male patient diagnosed as Ardita vata was treated with various Panchakarma procedures like Nasya, Shirobasti, Kukkutanda Swedana, Dashmoola Ksheer Dhoom, Gandoosh and oral Ayurveda medicines. Criteria of assessment was based on the scoring of House-Brackmann Facial Nerve Grading scale. After completion of Ayurveda treatment, the patient Shown almost complete recovery without any adverse effects. This case is an evi-dence to demonstrate the effectiveness of Ayurveda treatment in case of Ardita vata (Bell’s palsy).

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Association of Patients’ Characteristics with Acupuncture Treatment Outcomes in Treating Bell’s Palsy: Results from a Randomised Controlled Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2019/6073484 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Xianjun Xiao ◽

Qianhua Zheng ◽

Yunzhou Shi ◽

Leixiao Zhang ◽

Ling Zhao ◽

...

Keyword(s):

Acupuncture Treatment ◽

Controlled Trial ◽

Secondary Analysis ◽

Complete Recovery ◽

Bell’S Palsy ◽

Acute Stage ◽

Chorda Tympani ◽

Bell's Palsy ◽

Significant Difference ◽

Multicenter Randomized Controlled Trial

Background. Acupuncture has been found to be effective for treating Bell’s palsy (BP). However, which class of BP patients will have a better response to acupuncture remains uncertain and requires investigation. Methods. We performed a secondary analysis of a multicenter, randomized, controlled trial. BP patients were randomly divided into five acupuncture treatment groups. The degree of facial nerve recovery was assessed according to the House–Brackmann grading system (HB grade). Grade I was defined as complete recovery (CR), and grades II–VI were defined as incomplete recovery (IR). The relevant patient characteristics were collected and compared between CR and IR groups by univariate and logistic regression analyses. Results. Eight-hundred twenty-six subjects were analyzed. Among these, 698 (85%) subjects had a good prognosis. No significant difference in the effectiveness of the five treatments was observed (all P>0.05). The likelihood of IR increased by 2.2% with each one-year increase in age (odds ratio (OR) 1.022, 95% confidence interval (CI) 1.005–1.038; P=0.009). The likelihood of IR increased by 9% with each kg/m2 increase in BMI (OR 1.090, 95% CI 1.019–1.165; P=0.012). The likelihood of IR at the recovery stage was higher than that at the acute stage (OR 7.996, 95% CI 4.570–13.991; P<0.001), and the likelihood of IR of patients with lesions at or above the chorda tympani was higher than that of patients with lesions below the chorda tympani (OR 1.989, 95% CI 1.256–3.150; P=0.003). The likelihood of IR increased by 281.7% with each unit increase in the HB grade (OR 2.817, 95% CI 2.113–3.756; P<0.001). Conclusions. Younger patients at the acute stage of the disease with low BMIs, low initial HB grades, and lesions below the chorda tympani were more likely to respond to acupuncture.

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Pathogenesis of Bell's Palsy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348947708600416 ◽

1977 ◽

Vol 86 (4) ◽

pp. 549-558 ◽

Cited By ~ 16

Author(s):

Ruth Gussen

Keyword(s):

Facial Nerve ◽

Complete Recovery ◽

Bell’S Palsy ◽

Facial Canal ◽

Chorda Tympani ◽

Bell's Palsy ◽

Nerve Branch ◽

Collagen Formation ◽

Myelin Sheaths ◽

Metabolic Exchange

The pathogenesis of Bell's palsy is presented as retrograde epineurial compression edema with ischemia of the facial nerve. Although the etiology is unknown, an attractive theory is vasospasm, from any cause, along any facial nerve branch, with the chorda tympani, perhaps, the usual primary involvement. Retrograde vascular distension and edema, within the epineurium of the bony facial canal, compresses the nerve from outside its perineurial sheath. The compression force may be mild or severe, resulting in varying degrees of reversible or irreversible ischemic degeneration of myelin sheaths and axons, with varying degrees of cellular reaction to myelin breakdown. The edema may be resorbed, leaving reversible or irreversible nerve damage, or may stimulate collagen formation within the epineurium, with persisting fibrous compression (entrapment) neuropathy of the facial nerve. This concept is consistent with the varying results of Bell's palsy, and depends on the severity and duration of edema, and whether fibrosis occurs within the epineurium of the facial canal. Epineurial fibrosis also results in disturbance of metabolic exchange through the epineurial-permeurial-endoneurial tissues, and may ultimately result in obliteration of vascular drainage. Two temporal bone cases of Bell's palsy, one occurring ten years before death, with residual paralysis. and one two years before death, with clinical recovery, are added to the previously described four cases in the literature, three of early Bell's palsy, and one of remote palsy with almost complete recovery.

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Outcome of Treatment with Valacyclovir and Prednisone in Patients with Bell's Palsy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940311200301 ◽

2003 ◽

Vol 112 (3) ◽

pp. 197-201 ◽

Cited By ~ 33

Author(s):

Sara Axelsson ◽

Sven Lindberg ◽

Anna Stjernquist-Desatnik

Keyword(s):

Treatment Group ◽

Medical Treatment ◽

Antiviral Drug ◽

Complete Recovery ◽

Bell’S Palsy ◽

Adult Patients ◽

University Hospital ◽

Control Group ◽

Type I ◽

Bell's Palsy

Idiopathic facial paralysis, or Bell's palsy, shows a nonepidemic pattern that might indicate reactivation of a latent microorganism such as herpes simplex type I as a causative agent. Thirty percent of patients with Bell's palsy given no treatment will not recover completely, and 5% will have severe sequelae. The aim of this study was to find out whether treatment with an antiviral drug in combination with corticosteroids is more effective than no medical treatment at all in patients with Bell's palsy. Fifty-six consecutive adult patients attending the otorhinolaryngology department of the University Hospital of Lund from 1997 to 1999 were treated with 1 g of valacyclovir hydrochloride 3 times per day for 7 days and 50 mg of prednisone daily for 5 days, with the dose being reduced by 10 mg daily for the next 5 days. Fifty-six adult patients with Bell's palsy attending the same department between 1995 and 1996 who were given no medical treatment were studied retrospectively and used as the control group. Forty-nine patients (87.5%) in the treatment group recovered completely, as compared with 38 patients (68%) in the control group (p <.05). One patient (1.8%) in the treatment group displayed severe sequelae, defined as a House-Brackmann score of IV or worse, as compared with 10 of 56 patients (18%) in the control group (p <.01). Among patients over 60 years old, 10 of 10 in the treatment group had complete recovery, as compared with 5 of 12 patients in the control group (p <.01). The present study showed a significantly better outcome in patients with Bell's palsy treated with valacyclovir and prednisone as compared with patients given no medical treatment. This difference in outcome was especially pronounced among elderly patients.

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Role of Neuromuscular Electrical Stimulation in Bell’s Palsy: A Case Study of Three Patients

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20211034 ◽

2021 ◽

Vol 6 (4) ◽

pp. 235-241

Author(s):

Nasrin Bharti

Keyword(s):

Electrical Stimulation ◽

Neuromuscular Electrical Stimulation ◽

Complete Recovery ◽

Daily Basis ◽

Bell’S Palsy ◽

Bell's Palsy ◽

Early Management ◽

The Face ◽

Conventional Physiotherapy

Bell's palsy is an idiopathic, unilateral facial paralysis, caused by a malfunction anywhere along the facial nerve's peripheral portion, from the pons distally. Bell's palsy is treated by removing the cause of nerve injury, strengthening the face muscles, and restoring facial function. Physical therapy in the form of neuromuscular electrical stimulation (NMES), massage and facial exercises is used as adjuvant to hasten recovery. The aim of this study is to access of role of neuromuscular electrical stimulation (NMES) treatment in Bell’s palsy patients. A detailed neurological assessment of three patients was done with emphasis on facial muscles and severity of paralysis was graded according to House Brackmann scale (HBS). Conventional physiotherapy was given in the form of electrical stimulation, facial massage, exercises and functional re-education on a daily basis. Patients were assessed at weekly and 1months after the treatment. They experienced complete recovery within 1month follow-up, no recurrence was observed and all patients have normal facial movement. Physiotherapy in the form of NMES and facial exercises has a effective role in the early management of Bell’s palsy. Keywords: Bell’s palsy; neuromuscular electrical stimulation; House Brackmann scale; physiotherapy.

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Bell's palsy

InnovAiT Education and inspiration for general practice ◽

10.1177/17557380211046284 ◽

2021 ◽

Vol 14 (12) ◽

pp. 733-741

Author(s):

Frith Cull ◽

Holli Coleman

Keyword(s):

Facial Nerve ◽

Complete Recovery ◽

Rapid Onset ◽

Bell’S Palsy ◽

Bell's Palsy ◽

Ocular Complications ◽

The United Kingdom ◽

Common Diagnosis ◽

Nerve Paresis ◽

And Function

Bell's palsy is the term given to an idiopathic lower motor neurone facial nerve paresis or paralysis. It is of rapid onset, almost always unilateral, and may be associated with facial or retro-auricular pain or otalgia. It is the most common diagnosis associated with facial nerve palsy; a GP will see a case approximately every 2 years in practice in the United Kingdom. Early diagnosis and steroid treatment increase the likelihood of full recovery, whereas ocular complications can be prevented by lubricants and lid taping. Over 70% of patients recover within a year. Options to improve facial appearance and function, in those who do not experience a complete recovery, include surgery.

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Protracted COVID-19 during Treatment of Facial Palsy

Case Reports in Neurological Medicine ◽

10.1155/2021/5569841 ◽

2021 ◽

Vol 2021 ◽

pp. 1-3

Author(s):

Mehrdad Hasibi ◽

Maral Seyed Ahadi ◽

Hamed Abdollahi ◽

Mehrdad Jafari

Keyword(s):

Facial Palsy ◽

Antiviral Treatment ◽

Complete Recovery ◽

Bell’S Palsy ◽

Concomitant Treatment ◽

Neurologic Manifestations ◽

Bell's Palsy ◽

Peripheral Facial Palsy ◽

Case Summary

Neurologic manifestations are increasingly reported as the coronavirus disease 2019 (COVID-19) pandemic continues. This is a report of a COVID-19 patient with Bell's palsy. Case Summary. A 52-year-old man with fever and malaise was tested positive for COVID-19. After a week, he developed right-sided peripheral facial palsy and was treated with corticosteroids in conjunction with antiviral treatment which resulted in complete recovery. Discussion. Concomitant treatment of corticosteroids and antiviral treatment can decrease morbidity in patients with COVID-19-related Bell's palsy.

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Steroids with and Without Antivirals in the Treatment of Bell’s Palsy: Does It Make any Difference in Recovery? A Study at a Tertiary Care Center, Karachi, Pakistan

Archives of Neuroscience ◽

10.5812/ans.115645 ◽

2021 ◽

Vol 8 (3) ◽

Author(s):

Abu Talib ◽

Gohar Baloch ◽

Iftikhar Haider Naqvi ◽

Muhammad Ubaid

Keyword(s):

Quality Of Life ◽

Utility Score ◽

Health Utility ◽

Complete Recovery ◽

Bell’S Palsy ◽

Control Group ◽

Study Group ◽

Facial Appearance ◽

Bell's Palsy

Objectives: To compare the pharmacological effects of steroids in comparison to steroids with antiviral drugs for the treatment of Bell’s Palsy. Methods: A total 60 patients were enrolled and segregated equally into two groups, where patients on prednisolone were labeled as group A (Control group), whereas patients on prednisolone + acyclovir were labeled as group B (study group). All patients had House Brackmann score. The control group started oral prednisolone 1 mg/kg for 10 days, whereas the study group started acyclovir 400 mg 4 times a day for 10 days along with prednisolone tablets. Patients were regularly observed till the study was completed. Primary outcome measure was facial nerve recovery. Health-related quality of life and facial appearance were considered secondary outcomes. Results: The primary outcomes assessed as complete recovery from Bell’s Palsy by Brackmann score at week 4 were found in 17/30 (57%) patients and 23/30 (77%) patients at week 8 in the control group. Complete recovery from Bell’s Palsy was also shown in the experimental group (Prednisolone + acyclovir) where 25/30 (83%) patients completed recovery at week 4, while 27/30 (90%) patients at week 8. Comparison of the two groups showed a significant improvement in the study group (prednisolone + acyclovir) (P = 0.047) at week 4 and (P = 0.02) at week 8. The secondary outcomes were assessed as improvement in the quality of life and facial appearance from Bell’s Palsy. Health utility score was 0.84 ± 0.01 in the control group (On prednisolone) with facial appearance score of (Derriford appearance scale 59) 61 ± 28. At week 4, the study group (on prednisolone+ acyclovir) showed 0.88 ± 0.12 score on Health utility index scale-3 and 46 ± 26 score on Derriford appearance scale. Comparison of the quality of life (Health quality index scale-3) and facial appearance among both control and study groups showed a significant improvement in the study group (P = 0.001 and P = 0.005, respectively). Moreover, when health utility score and Derriford appearance were compared among both groups, it showed a significant improvement in the study group (P = 0.001 and 0.016, respectively). Conclusions: The combination of prednisolone with acyclovir is found superior to prednisolone alone, and this combination treatment results in improvement in both recovery and quality of life.

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