Clinical Practice Guideline: Bell's Palsy Executive Summary

Baugh, Reginald F.; Basura, Gregory J.; Ishii, Lisa E.; Schwartz, Seth; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A.; Dawson, Cindy; Driscoll, Colin L. W.; Gillespie, M. Boyd; Gurgel, Richard K.; Halperin, John J.; Khalid, Ayesha N.; Kumar, Kaparaboyna Ashok; Micco, Alan G; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

doi:10.1177/0194599813506835

Cited by 83 publications

(47 citation statements)

References 23 publications

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“…However recently published guidelines on diagnosis and management of Bell's palsy by the American Academy of Otolaryngology-Head and Neck Surgery Foundation stated that clinicians should not routinely perform diagnostic imaging for patients with new onset Bell's palsy, which we followed in our study. (10) In conclusion, the results of this study indicate possible involvement of the superior branch of the vestibular nerve in patients with Bell's palsy. Further studies combining caloric testing, stapedial reflex testing and VEMP on a larger number of patients should be performed in order to give definitive conclusions.…”

supporting

confidence: 51%

Vestibular evoked myogenic potentials in Bell’s palsy

2014

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The aim of the present study was to evaluate vestibular nerve involvement in patients with Bell's palsy with ocular and cervical vestibular evoked myogenic potentials (oVEMP and cVEMP). Ten patients who were diagnosed with Bell's palsy and ten healthy controls were included. All patients underwent VEMP recordings within six days after their initial presentation. Patients with Bell's palsy had greater oVEMP asymmetry ratio comparing to healthy controls (-38,4±28,7% vs -1,3±19.3%, p=0.005). As well N10 latencies of the oVEMP response were prolonged comparing to healthy controls (11.575 vs 9.72 ms).There was no difference in cVEMP asymmetry ratio or latencies between groups.We found no correlation between House-Brackmann grading scale and oVEMP asymmetry ratio (r=0.003, p=0,994). There are three possible explanations for increased oVEMP amplitudes on the affected side: 1) oVEMP response on the ipsilateral eye could be contaminated by facial nerve activity (blink reflex); 2) the amplitude of n10-p33 could be affected through the stapedial reflex; and 3) increased oVEMP amplitude could be the consequence of the vestibular nerve dysfunction itself, with prolonged latencies of the N10 oVEMP further supporting this explanation. The results of this study indicate possible involvement of the superior branch of the vestibular nerve in patients with Bell's palsy.

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confidence: 51%

Vestibular evoked myogenic potentials in Bell’s palsy

2014

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“…Even without treatment, a large number of patients (approximately 70%) recover completely within 6 months and approximately 30% of patients may not recover completely. [ 14 15 ] We noted that approximately 80% patients recovered completely at 3 months of treatment with either IV methylprednisolone or oral prednisolone. Intravenous methylprednisolone resulted in nonsignificantly better functional recovery rate especially at 1-month when assessed against oral prednisolone and in terms of early institution of treatment (≤3 days).…”

Section: Discussionmentioning

confidence: 99%

Single dose intravenous methyl prednisolone versus oral prednisolone in Bell′s palsy: A randomized controlled trial

et al. 2015

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Objectives:Corticosteroids have been used in the treatment of Bell's palsy and several other postinfectious neurological conditions. We hypothesized that administration of a single dose of intravenous (IV) methylprednisolone might be an effective alternative to oral prednisolone.Materials and Methods:In this open label, randomized trial, patients with acute Bell's palsy were randomized into two groups. One group received single dose (500 mg) of IV methylprednisolone while the other group received 10 days of oral prednisone. Outcome was assessed at 1 and 3 months with House–Brackmann scale.Results:At 3 months, 93 (79.48%) patients had completely recovered. IV methylprednisolone and oral prednisolone groups had similar recovery rates (80% vs. 78.33%, P > 0.05). Patients with Grade 2 and 3 recovered completely. In patients with Grade 6, the recovery rate was 20%. A better outcome was observed if corticosteroids were administered within 3 days of onset of palsy.Conclusion:Intravenous methylprednisolone and oral prednisolone showed equivalent benefit in patients with acute Bell's palsy.

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“…In addition, we did not perform electrodiagnostic testing procedures, such as electroneurophysiological testing and facial electromyography, for several reasons. Electrophysiological assessment is used for complete facial paralysis after a minimum of 7 days and a maximum of 14 days after the onset of paralysis [ 3 ] to determine the prognosis of disease. However, the participants in our trial were those with sequelae of Bell’s palsy whose onsets were longer than six months.…”

Section: Discussionmentioning

confidence: 99%

“…The condition occurs in 30/100,000 individuals per year, and approximately 30 % of patients have sequelae, such as unrecovered paresis, contracture of facial muscles, facial spasms, or synkinesis [ 2 ]. Because most symptoms recover within 6 months, the sequelae of Bell’s palsy are defined as facial palsy conditions that persist 6 months after the onset of symptoms [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Acupuncture for the sequelae of Bell’s palsy: a randomized controlled trial

Kwon

Choi

Lee

et al. 2015

Trials

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BackgroundIncomplete recovery from facial palsy results in social and physical disabilities, and the medical options for the sequelae of Bell’s palsy are limited. Acupuncture is widely used for Bell’s palsy patients in East Asia, but its efficacy is unclear.MethodsWe performed a randomized controlled trial including participants with the sequelae of Bell’s palsy with the following two parallel arms: an acupuncture group (n = 26) and a waiting list group (n = 13). The acupuncture group received acupuncture treatments for 8 weeks, whereas the waiting list group did not receive acupuncture treatments during the 8-week period after randomization. The primary outcome measure was change in the Facial Disability Index (FDI) social and well-being subscale at week 8. We also analyzed changes in the FDI physical function subscale, the House–Brackmann score, the Sunnybrook Facial Nerve Grading system, lip mobility and stiffness at 5 and 8 weeks after randomization. An intention-to-treat analysis was applied.ResultsThe acupuncture group exhibited greater improvements in the FDI social score (mean difference, 23.54; 95 % confidence interval, 12.99 to 34.08) and better results on the FDI physical function subscale (mean difference, 21.54; 95 % confidence interval, 7.62 to 35.46), Sunnybrook Facial Nerve Grading score (mean difference, 14.77; 95 % confidence interval, 5.05 to 24.49), and stiffness scale (mean difference, −1.58; 95 % confidence interval,−2.26 to −0.89) compared with the waiting list group after 8 weeks. No severe adverse event occurred in either group.ConclusionCompared with the waiting list group, acupuncture had better therapeutic effects on the social and physical aspects of sequelae of Bell’s palsy.Trial registrationCurrent Controlled Trials ISRCTN43104115.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0777-z) contains supplementary material, which is available to authorized users.

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Clinical Practice Guideline: Bell's Palsy Executive Summary

Abstract: The American Academy of Otolaryngology-Head and Neck

Cited by 83 publications

References 23 publications

Vestibular evoked myogenic potentials in Bell’s palsy

Vestibular evoked myogenic potentials in Bell’s palsy

Single dose intravenous methyl prednisolone versus oral prednisolone in Bell′s palsy: A randomized controlled trial

Acupuncture for the sequelae of Bell’s palsy: a randomized controlled trial

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