Outcome of Bell’s Palsy- An Institutional Study

Background and purpose: Bell’s palsy represents sudden onset of lower motor neuron type of facial palsy in the absence of other cranial nerve involvement. Pathophysiologically, it has been described mostly due to viral infection, and early use of antiviral therapy, steroids and physiotherapy has shown to limit the disease and helps in early recovery from palsy. With the objective to evaluate over all clinical outcome of the patients presented with Bell’s palsy with our treatment strategies this study was performed. Material and method: This is a prospective analytical study with non probability consecutive sampling technique over the duration of 6 months. Continuous variable like age is presented using mean and standard deviation. Categorical data are presented as percentage and analysis of outcome of the treatment is done using Fischer’s exact test. Statistical analysis was done using SPSS -20. Result: Total number of patients enrolled in the study was 19, where mean age was 33.47 (SD 15.71) years. Bell’s palsy was more commonly seen in female patients (58%). House Brackmann grading of facial nerve palsy at the time of presentation was four. There was significant association of early treatment with complete recovery in this study. Conclusion: Early treatment of bells palsy with acyclovir, steroids, and physiotherapy has shown promising result in most of the studies; and this holds true in this study as well, where delaying the treatment was significantly associated with poorer recovery.

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Prednisolone versus Prednisolone combined with Acyclovir for the Treatment of Bell's Palsy: A Comparative Study in Peripheral Referral Centre

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i2.20942 ◽

2018 ◽

Vol 3 (2) ◽

pp. 443-446

Author(s):

Karuna Shrestha ◽

Rajeev Shah ◽

Srijana Sapkota ◽

Sandarva Giri

Keyword(s):

Controlled Trial ◽

Combined Therapy ◽

Bell’S Palsy ◽

Sudden Onset ◽

P Value ◽

Bell's Palsy ◽

Early Recovery ◽

Cross Sectional ◽

Female Ratio ◽

Number Of Patients

Introduction: Bell's palsy is an idiopathic facial nerve palsy of sudden onset, usually, unilateral. Recent evidence suggests association of Herpes simplex infection with Bell's palsy but exact cause is unknown. Prednisolone are widely used in the treatment of Bell's palsy. However, the efficacy of additional treatment with acyclovir is uncertain.Objective: To evaluate whether a prednisolone with acyclovir provide a better degree of facial muscle recovery outcomes than prednisolone alone in patient with Bell's palsy.Methodology: This is a hospital based longitudinal cross sectional study conducted in Birat Medical College and Teaching Hospital and Birat Hospital PVT LTD, Biratnagar, Nepal from January 2017 to May 2018. A total of 42 patient diagnosed with Bell's palsy are included in this study, where 21 patient are treated with prednisolone and remaining 21 patient treated with a combination of prednisolone and acyclovir. The House-Brackmann grading scale is used for recording the initial presentation of patient with Bell's palsy and their early recovery on follow-up visit. The collected data was analysed using SPSS 18.0.Results: The total number of patients included in this study was 42. Mean age of patients is 27.1±10 years. Among them 25 (59.5%) were male and 17(40.5%) were female where male and female ratio is 1.5:1. Prednisolone plus acyclovir given in combination in Bell's palsy patients has as 76.2% recovery while prednisolone given alone has a 57.1% recovery P value <0.195, odds ratio 2.400 (95% confidence interval 0.638 – 9.028).Conclusions: Prednisolone and acyclovir, the combined therapy is effective than prednisolone alone in the treatment of Bell's palsy. It requires confirmation with randomized controlled trial. BJHS 2018;3(2)6: 443-446

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Epidemiological Study of Bell's Palsy in patients From Western Nepal

Eastern Green Neurosurgery ◽

10.3126/egn.v2i2.29259 ◽

2020 ◽

Vol 2 (2) ◽

pp. 41-46

Author(s):

Krishna Prasad Koirala

Keyword(s):

Young Adults ◽

Facial Nerve ◽

Motor Neuron ◽

Facial Paralysis ◽

Bell’S Palsy ◽

Sudden Onset ◽

Lower Motor Neuron ◽

Bell's Palsy ◽

Short Term ◽

Early Recovery

Background: Bell's palsy is defined as idiopathic, sudden onset, unilateral lower motor neuron facial paralysis. The etiology of Bell's palsy is unclear. It affects all age ranges with complete recovery in most cases. However, few patients are left with a considerable permanent functional deficit. The disease has variable progression ranging from few hours to days. Diagnosis is usually made when a patient presents with sudden onset unilateral lower motor neuron facial paralysis without an obvious cause. Different medical therapies such as steroids, antivirals, physiotherapy, acupuncture, etc. have been used to enhance the recovery of Bell's palsy. This study aims to find out the common age of presentation of people with Bell's palsy, and also to report their outcome with the use of steroids. Materials and methods: This study is a prospective observational study carried out in the department of ENT and Head and neck surgery at Manipal College of Medical Sciences, Pokhara, Nepal. Patients of all ages and both sex with the diagnosis of Bell's palsy meeting the inclusion criteria were studied from 1st Jan 2015 to 31st Dec 2018. Data were taken and analyzed with the help of SPSS software and results were published. Results: Out of 45 patients of Bell's palsy enrolled in the study, females outnumbered the males. Bell's palsy was more commonly seen in young adults There was a significant short-term improvement in Bell's palsy with the use of steroids (p=0.00001). There was no difference in early recovery after Bell's palsy regardless of the time of presentation within a week or age of the patient at presentation. Conclusion: Bell's palsy is more common in young adults. Steroids have a definite role in the short-term improvement of facial nerve function. People presenting within a week of facial nerve palsy can be treated with steroids. People of all ages can equally improve with steroid treatment.

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Clinical Study of Bell's Palsy at Tertiary Care: Our Experience

Annals of Otology and Neurotology ◽

10.1055/s-0039-1693096 ◽

2019 ◽

Vol 02 (01) ◽

pp. 16-20

Author(s):

M. B. Bharathi ◽

Thanzeem Unisa ◽

Swathi Chandresh ◽

Venkatesh C. R. ◽

Harsha S.

Keyword(s):

Facial Nerve ◽

Tertiary Care ◽

Bell’S Palsy ◽

Cross Sectional Study ◽

Bell's Palsy ◽

Cross Sectional ◽

Tertiary Referral Center ◽

Number Of Patients ◽

The Face ◽

History Of

Abstract Introduction Bell's palsy (BP) is the common cause of facial palsy. This study aims to report and analyze the age, sex distribution, symptomatology, site of lesion, and prognosis in 101 patients with (BP). Materials and Methods This is a cross-sectional study conducted at tertiary referral center, JSS Hospital, Mysuru. All patients consenting to participate in this study, of all ages, of either sex, both outpatients and inpatients with a diagnosis of BP during this study period were included. Results Of the 101 patients analyzed, maximum cases (25.7%) were in third decade of age; 55.4% were males, and both right and left sides of the face were equally involved. Maximum number of patients (50.5%) had a history of postaural pain at presentation Topodiagnostic tests showed majority of BP cases involving geniculate or suprageniculate regions (67.3%) in our study. 20.8% had lesion above the nerve to stapedius, and 11.9% had lesion below the nerve to stapedius. Electrodiagnostic test—electroneuromyography (ENMG)—was abnormal in 57 (67.1%) individuals at day 4. 50.4% of patients had a House-Brackmann (HB) facial nerve grade IV at presentation. 90% of the BP group in our study recovered normal to near-normal facial nerve function by the end of 28 days’ time. Conclusion Each case of BP should be evaluated with thorough clinical examination, topodiagnostic tests, and electrodiagnostic tests. Appropriate management will help in almost full recovery of disease.

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Prognostic Factors Associated With Recovery in Children With Bell’s Palsy

Journal of Child Neurology ◽

10.1177/0883073819865672 ◽

2019 ◽

Vol 34 (14) ◽

pp. 891-896 ◽

Cited By ~ 1

Author(s):

Elif Karatoprak ◽

Sila Yilmaz

Keyword(s):

Prognostic Factors ◽

Facial Nerve ◽

Bell’S Palsy ◽

Steroid Treatment ◽

Grading System ◽

Bell's Palsy ◽

Early Recovery ◽

Laboratory Findings ◽

Distribution Width ◽

Factors Affecting

Objectives: The aim of the study was to determine the prognosis of children with Bell’s palsy and analyze the prognostic factors affecting early recovery. Methods: The records of children with a diagnosis of Bell’s palsy were retrospectively analyzed. Demographic and clinical features including age, gender, House-Brackmann Facial Nerve Grading System House-Brackmann Grading Scale (HBGS) grade at admission and follow-up, and the dosage and onset of steroid treatment were reviewed. Laboratory findings such as red blood cell distribution width and neutrophil-to-lymphocyte ratio were noted. The patients who were recovered within the first month (early recovery) were compared with the patients who were recovered after first month (late recovery) in terms of demographic, clinical characteristics, laboratory findings and treatment modalities in order to determine the risk factors affecting early recovery. Results: A total of 102 children (65 girls and 37 boys) with a mean age of 10.37 ± 4.2 years were included in the study. The complete recovery was detected in 101 children (%99) with Bell’s palsy. Statistically significant difference was found in terms of dosage and time of onset of steroid treatment ( P = .04, P = .035, respectively) and House-Brackmann Facial Nerve Grading System grade on the 10th day ( P = .001) between the early and late recovery groups. Conclusion: The prognosis of Bell’s palsy in children was very good. The prognostic factors affecting the early recovery were being House-Brackmann Facial Nerve Grading System grade 2 or 3 on the 10th day and receiving steroid treatment in the first 24 hours. Neutrophil-to-lymphocyte ratio and red blood cell distribution width were not found to be predictive factors for early recovery.

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