Bell's Palsy and Tinnitus during Pregnancy: Predictors of Pre-eclampsia?: Three Cases and a Detailed Review of the Literature

Abstract

We present two cases of Bell's palsy, and another with tinnitus, all in association with pre-eclampsia in the third trimester of pregnancy. We also systematically reviewed the published literature on both Bell's palsy and tinnitus in pregnancy and the puerperium using Medline from January 1966 to October 1998, and searched through the references from review articles and original research publications for further studies. Studies were limited to those published in the English language. We then pooled the rates of occurrence for Bell's palsy according to trimester of pregnancy, and postpartum, as well as the associated prevalence of pre-eclampsia or gestational hypertension. We found that the majority of cases of Bell's palsy arose during the third trimester (pooled event rate 71.1%, 95% confidence interval (CI) 64.1-77.2), while almost none arose in the first trimester. During the postpartum period, the distribution of Bell's palsy was 21.3% (95% CI 15.7-28.1) of all cases, with the majority arising within days of delivery. Gestational hypertension or pre-eclampsia was present in 22.2% of cases (95% CI 12.5-36.4), well above the 5% rate in the general population. Only one paper provided data on tinnitus in pregnancy, with the distribution equal across all three trimesters. When compared to non-pregnant controls, the odds ratio for the development of tinnitus during pregnancy was 2.8 (95% CI 1.0-8.1). In conclusion, Bell's palsy, and perhaps, tinnitus, occur more frequently during the third trimester of pregnancy. Both may be presenting prodromal signs of underlying early pre-eclampsia. The pathophysiologic mechanism relating these two entities to pre-eclampsia is also discussed.

Independent Role of Hypertension in Bell’s Palsy: A Case-Control Study

“…Contrary to diabetes there is less evidence in the literature for hypertension to cause or predispose to Bell’s palsy in the general population [5,6,7,12,13,14,15,28,29,30]. There has been more attention on hypertension in Bell’s palsy among children and pregnant women [31,32,33,34,35,36,37]. The incidence of Bell’s palsy is significantly higher during the last trimester of pregnancy and the puerperium.…”

LMN Facial Palsy in Pregnancy: An Opportunity to Predict Preeclampsia—Report and Review

“…Most cases are confined to the third trimester and the immediate postpartum period [5]. Several physiological changes during pregnancy have been proposed to explain this association.…”

“…Bell's palsy during pregnancy has been associated with preeclampsia [5, 13]. Physiological changes involved in pathogenesis of Bell's palsy during pregnancy are common with the etiopathogenesis of preeclampsia which explains the high incidence of preeclampsia in women with Bell's palsy.…”

“…Though it is not clear whether Bell's palsy is temporally related to preeclampsia, in many cases [5, 14–17] Bell's palsy is seen to occur before the onset of severe preeclampsia, superimposed preeclampsia, or HELLP (Table 1). It is possible that the edematous state in pregnancy, which is exaggerated in preeclampsia, manifests as isolated neurological deficit among which Bell's palsy is the most obvious one.…”

“…Use of steroids has been found to improve recovery [19, 20]. Some authors consider treatment with steroids as superfluous [5, 21]. High rate of spontaneous recovery after delivery has been observed and this has been associated with higher levels of endogenous steroids during pregnancy, younger age of this population, and resolution of physiological and anatomical changes after birth of the baby.…”