Epidemiology, clinical features, and treatment modalities of facial nerve palsy in COVID-19 patients: a systematic review

Abstract

Background Coronavirus disease 2019 (COVID-19) is responsible for a wide variety of multi-system clinical features. Facial nerve palsy (FNP) is identified as one of the neurological complications of the virus. This work aims to systematically review the clinical picture, laboratory/imaging findings, treatment options, and prognostic factors of FNP in COVID-19 patients. Methods Using six online databases, a search was conducted to include all articles with patients infected with COVID-19 and presenting with unilateral or bilateral FNP. Screening for eligibility and data extraction were done by three and four independent reviewers, respectively. Descriptive analyses and data visualizations were done using Google Sheets. Survival analysis and Kaplan–Meier plotting were done by R software. Results The data from 22 studies included 32 patients who were infected with COVID-19 and presented with clinical features of FNP. Fourteen patients were male while 18 were female. FNP affected 29 patients unilaterally and 3 patients bilaterally. The imaging findings confirmed that complications of FNP were COVID-19 related. Additionally, antivirals combined with steroids had the lowest median time (21, IQR = 8) to clinical improvement compared to steroid-only (30, IQR = 15) and antiviral-only (33, IQR = 3.5) treatments. Conclusion This study has shown a potential correlation between the increased incidence of FNP and COVID-19. We have also found that combining antivirals with steroids may have better outcomes in patients with FNP and COVID-19 although the evidence to support this claim is not strong enough. Further studies are required to assess the extent of linkage between the two conditions and how to properly manage FNP when encountered in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13760-022-02026-8.

An online survey on clinical characteristics of otologic symptoms linked to COVID-19 infection

“…Last but not least, some researches have reported that COVID-19 may cause facial nerve palsy (54,55). Mehrdad Estakh et al (11) have shown that there is enough evidence suggesting that patients with COVID-19 infection may present with facial palsy as the initial clinical manifestation.…”

Korean Medicine Treatments in Threepatients with Bell’s Palsy after Coronavirus Disease 2019 Infection: A Retrospective Case Series

“…However, the impact of Bell's palsy after SARS-CoV-2 infection has not been investigated. Turki et al [12] reported a complete recovery rate of 62.5% in 32 patients with Bell's palsy after COVID-19 infection, which is similar to the complete recovery rate of 71% [5] for patients with Bell's palsy that were not diagnosed with COVID-19. However, Uysal and Güllüoğlu [13] reported that the complete recovery rate decreased from 88.2% before the COVID-19 pandemic to 28.9% during the COVID-19 pandemic.…”

Neuromuscular Disorders Associated With COVID-19

“…A systematic review found a pool of 32 patients who had been treated for Bell's palsy, and a combination of antivirals and steroids led to a faster resolution of symptoms than steroids or antivirals alone. 23 Other cranial nerve deficits have occurred in association with COVID-19 infection including oculomotor (CN III) and abducens (CN VI). 15 The vestibulocochlear nerve (CN VIII) was affected in the form of tinnitus or hearing changes in 13.2% of severe COVID-19 survivors, though this may be confounded by commonly used medications such as furosemide in severe infections.…”