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Antiviral agents convey added benefit over steroids alone in Bell's palsy; decompression should be considered in patients who are not recovering

Published online by Cambridge University Press:  24 April 2015

J A De Ru ,
P A Brennan  and
E Martens
J A De Ru*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Central Military Hospital, Utrecht, the Netherlands
P A Brennan
Affiliation:
Department of Oral and Maxillofacial Surgery, University of Portsmouth, UK
E Martens
Affiliation:
Statisticor, Rotterdam, the Netherlands
*
Address for correspondence: Dr J A de Ru, Department of Otolaryngology – Head and Neck Surgery, Central Military Hospital ‘Dr A Mathijsen’, Lundlaan 1, 3584EZ Utrecht, the Netherlands E-mail: [email protected]
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Abstract

Background:

The management of Bell's palsy has been the subject of much debate, with corticosteroids being the preferred medication. However, evidence also supports the use of antiviral drugs for severe cases and even decompression surgery in patients who, despite medical treatment, are not recovering.

Method:

A literature review was conducted on the management of Bell's palsy.

Results:

This paper describes the background, statistical evidence, study results and pathophysiological theories that support more aggressive treatment for patients with severe palsy and those who have inadequate recovery.

Conclusion:

Combination therapy including antiviral medication significantly improves outcomes in patients with severe Bell's palsy. Decompression should be considered in patients who have not recovered with drug treatment.

Keywords

Antiviral AgentsFacial NerveTreatment OutcomeDrug TherapyHuman
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 4 , April 2015 , pp. 300 - 306
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Walker, DT, Hallam, MJ, Ni Mhurchadha, S, McCabe, P, Nduka, C. The psychosocial impact of facial palsy: our experience in one hundred and twenty six patients. Clin Otolaryngol 2012;37:474–7Google Scholar
2Gilden, DH. Bell's palsy. N Engl J Med 2004;351:1323–31Google Scholar
3Pulec, JL. Acute facial paralysis. In: Pensak, ML. Controversies in Otolaryngology. New York: Thieme Medical Publishers, 2001;223–6Google Scholar
4Pulec, JL. Early decompression of the facial nerve in Bell's palsy. Ann Otol Rhinol Laryngol 1981;90(6 Pt 1):570–7CrossRefGoogle ScholarPubMed
5Mulley, AG, Trimble, C, Elwyn, G. Stop the silent misdiagnosis: patients’ preferences matter. BMJ 2012;345:ee6572Google Scholar
6Rawlins, M. De testimonio: on the evidence for decisions about the use of therapeutic interventions. Lancet 2008;372:2152–61CrossRefGoogle ScholarPubMed
7McNeill, R. Facial nerve decompression. J Laryngol Otol 1974;88:445–55Google Scholar
8Gantz, B, Rubinstein, JT, Gidley, P, Woodworth, GG. Surgical management of Bell's palsy. Laryngoscope 1999;109:1177–88Google Scholar
9Cawthorne, T. The pathology and surgical treatment of Bell's palsy. Proc R Soc Med 1951;44:565–72Google Scholar
10Aminoff, MJ. Bell's palsy and its treatment. Postgrad Med J 1973;49:46–51Google Scholar
11Ney, KW. Facial paralysis and the surgical repair of the facial nerve. Laryngoscope 1922;5:327–47Google Scholar
12Van der Graaf, RC, Ijpma, FFA, Nicolai, JP, Werker, PMN. Bell's palsy before Bell: Evert Jan Thomassen à Thuessink and idiopathic peripheral facial paralysis. J Laryngol Otol 2009;123:1193–8CrossRefGoogle Scholar
13Sade, J. Pathology of Bell's palsy. Arch Otolaryngol 1972;95:406–13Google Scholar
14McCormick, DP. Herpes-simplex virus as cause of Bell's palsy. Lancet 1972;1:937–9Google Scholar
15Murakami, S, Mizobuchi, M, Nakashiro, Y, Doi, T, Hato, N, Yanagihara, N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med 1996;124:27–30Google Scholar
16Holland, NJ, Weiner, GM. Recent developments in Bell's palsy. BMJ 2004;329:553–7CrossRefGoogle ScholarPubMed
17Alberton, DL, Zed, PJ. Bell's palsy: a review of treatment using antiviral agents. Ann Pharmacother 2006;40:1838–42Google Scholar
18Finsterer, J. Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngol 2008;265:743–52Google Scholar
19Yeo, SG, Lee, YC, Park, DC, Cha, CI. Acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy. Am J Otolaryngol 2008;29:163–6CrossRefGoogle ScholarPubMed
20Kennedy, PG. Herpes simplex virus type 1 and Bell's palsy – a current assessment in the controversy. J Neurovirol 2010;161:1–5Google Scholar
21Morris, WM. Surgical treatment of Bell's palsy. Lancet 1938;19:429–31Google Scholar
22Morgan, M, Moffat, M, Ritchie, L, Collacott, I, Brown, T. Is Bell's palsy a reactivation of varicella zoster virus? J Infect 1995;30:29–36Google Scholar
23Hato, N, Murakami, S, Gyo, K. Steroid and antiviral treatment for Bell's palsy. Lancet 2008;37:1818–20CrossRefGoogle Scholar
24Hato, N, Yamada, H, Kohno, H, Matsumoto, S, Honda, N, Gyo, K et al. Valacyclovir and prednisolone treatment for Bell's palsy: a multicenter, randomized, placebo-controlled study. Otol Neurotol 2007;28:408–13Google Scholar
25Hato, N, Matsumoto, S, Kisaki, H, Takahashi, H, Wakisaka, H, Honda, N et al. Efficacy of early treatment of Bell's palsy with oral acyclovir and prednisolone. Otol Neurotol 2003;24:948–51CrossRefGoogle ScholarPubMed
26Duel, AB. The operative treatment of facial palsy. Br Med J 1934;2:1027–32Google Scholar
27Giancarlo, HR, Mattucci, KF. Facial palsy; facial nerve decompression. Arch Otolaryngol 1970;91:30–6CrossRefGoogle ScholarPubMed
28Kettel, K. Pathology and surgery of Bell's palsy. Laryngoscope 1963;73:837–49Google Scholar
29Jongkees, LBW. On peripheral facial nerve paralysis. Arch Otolaryngol 1972;95:317–23Google Scholar
30Hagino, K, Tsunoda, A, Tsunoda, R, Kishimoto, S. Measurement of the facial nerve calibre in facial palsy: implications for facial nerve decompression. Otol Neurotol 2011;32:686–9Google Scholar
31Yanagihara, N, Honda, N, Hato, N, Murakami, S. Edematous swelling of the facial nerve in Bell's palsy. Acta Otolaryngol 2000;120:667–71Google ScholarPubMed
32Taverner, D. Bell's palsy: a clinical and electromyographic study. Brain 1955;78:209–10CrossRefGoogle ScholarPubMed
33McGovern, FH, Hansel, JS. Decompression of the facial nerve in experimental Bell's palsy. Laryngoscope 1961;71:1090–104CrossRefGoogle Scholar
34McGovern, FH. A review of the experimental aspects of Bell's palsy. Laryngoscope 1968;78:324–34Google Scholar
35Millen, SJ, Daniels, D, Meyer, G. Gadolinium-enhanced magnetic resonance imaging in facial nerve lesions. Otolaryngol Head Neck Surg 1990;102:26–33CrossRefGoogle ScholarPubMed
36Murai, A, Kariya, S, Tamura, K, Doi, A, Kozakura, K, Okano, M et al. The facial nerve canal in patients with Bell's palsy: an investigation by high-resolution computed tomography with multiplanar reconstruction. Eur Arch Otorhinolaryngol 2013;270:2035–8CrossRefGoogle ScholarPubMed
37Ge, XX, Spector, GJ. Labyrinthine segment and geniculate ganglion of facial nerve in fetal and adult human temporal bones. Ann Otol Rhinol Laryngol Suppl 1981;90:1–12Google Scholar
38Peitersen, E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;(549):4–30Google Scholar
39Mathews, WB. Prognosis in Bell's palsy. Br Med J 1961;2:215–17Google Scholar
40Pickerill, HP, Pickerill, CM. Early treatment of Bell's palsy. Br Med J 1945;2:457–9Google Scholar
41Tumarkin, IA. Some aspects of the problem of facial paralysis. Proc R Soc Med 1936;29:1685–91Google ScholarPubMed
42Lejeune, D, Bernat, I, Vitte, E, Lamas, G, Willer, JC, Soudant, J et al. Treatment of Bell's palsy with acyclovir and methylprednisolone [in French]. Ann Otolaryngol Chir Cervicofac 2002;119:209–15Google Scholar
43Ryu, EW, Lee, HY, Lee, SY, Park, MS, Yeo, SG. Clinical manifestations and prognosis of patients with Ramsay Hunt syndrome. Am J Otol 2012;33:313–18Google Scholar
44Langworth, EP, Taverner, D. The prognosis in facial palsy. Brain 1963;86:465–80CrossRefGoogle ScholarPubMed
45Williamson, IG, Whelan, TR. The clinical problem of Bell's palsy: is treatment with steroids effective? Br J Gen Pract 1996;46:743–7Google ScholarPubMed
46Kanazawa, A, Haginomori, S, Takamaki, A, Nonaka, R, Araki, M, Takenaka, H. Prognosis for Bell's palsy: a comparison of diabetic and nondiabetic patients. Acta Otolaryngol 2007;127:888–91CrossRefGoogle ScholarPubMed
47Pulec, JL. Bell's palsy: diagnosis, management and results of treatment. Laryngoscope 1974;84:2119–40Google Scholar
48Dalton, GA. Bell's palsy: some problems of prognosis and treatment. Br Med J 1960;1:1765–70Google Scholar
49Peiris, OA, Miles, DW. Galvanic stimulation of the tongue as a prognostic index in Bell's palsy. Br Med J 1965;2:1162–3Google Scholar
50De Ru, JA, Van Benthem, PPG, Janssen, LM. All evidence is equal, but some is more equal than others. Otol Neurotol 2010;31:551–3Google Scholar
51House, JW, Brackmann, DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985;93:146–7Google Scholar
52Browning, GG. A facial palsy grading system that appears to be invalid. Clin Otolaryngol 2007;32:396Google Scholar
53Wormald, RN, Ahmed, I, Fenton, JE. The facial nerve: one editorial, two authors, top-cited. Clin Otolaryngol 2007;32:397–8Google Scholar
54De Ru, JA, Braunius, WW, Van Benthem, PP, Busschers, WB, Hordijk, GJ. Grading facial nerve function. Why a new grading system, the MoReSS, should be proposed. Otol Neurotol 2006;27:1030–6CrossRefGoogle Scholar
55Brown, JS. Bell's palsy: a 5 year review of 174 consecutive cases: an attempted double blind study. Laryngoscope 1982;92:1369–73Google Scholar
56Tang, IP, Lee, SC, Shashinder, S, Raman, R. Outcome of patients presenting with idiopathic facial nerve paralysis (Bell's palsy) in a tertiary centre--a five year experience. Med J Malaysia 2009;64:155–8Google Scholar
57Shafshak, TS, Essa, AY, Bakey, FA. The possible contributing factors for the success of steroid therapy in Bell's palsy: a clinical and electrophysiological study. J Laryngol Otol 1994;108:940–3CrossRefGoogle ScholarPubMed
58Taverner, D, Cohen, SB, Hutchinson, BC. Comparison of corticotrophin and prednisolone in treatment of idiopathic facial paralysis (Bell's palsy). Br Med J 1971;4:20–2CrossRefGoogle ScholarPubMed
59Stillman, JS, Niparko, JK, Lee, SS, Lileny, PR. Prognostic value of evoked and standard electromyography in acute facial paralysis. Otolaryngol Head Neck Surg 1992;107:377–81CrossRefGoogle Scholar
60Thomander, L, Stalberg, E. Electroneurography in the prognostication of Bell's palsy. Acta Otolaryngol 1981;92:221–37Google Scholar
61Steiner, JF. Treatment of Bell palsy; translating uncertainty into practice. JAMA 2009;302:1003–4Google Scholar
62Thaera, GM, Wellik, KE, Barrs, DM, Dunckley, ED, Wingerchuk, DM, Demaerschalk, BM. Are corticosteroid and antiviral treatments effective for Bell palsy? A critically appraised topic. Neurologist 2010;16:138–40Google Scholar
63Adour, KK, Ruboyianes, JM, Von Doersten, PG, Byl, FM, Trent, CS, Quesenberry, CP Jr et al. Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial. Ann Otol Rhinol Laryngol 1996;105:371–8CrossRefGoogle Scholar
64De Ru, JA, Martens, EP, Van der Veen, EL. Antivirals for a possible viral cause (Rapid response to Quant et al., 1 November 2011). BMJ 2009;339:b3354Google Scholar
65Burgess, LPA, Yim, DWS, Lepore, ML. Bell's palsy: the steroid controversy revisited. Laryngoscope 1984;94:1472–6Google Scholar
66Moher, D. The problem of duplicate systematic reviews. BMJ 2013;347:f5040CrossRefGoogle ScholarPubMed
67Quant, EC, Jeste, SS, Muni, RH, Cape, AV, Bhussar, MK, Peleg, AY. The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis. BMJ 2009;339:b3354. Erratum in: BMJ 2013;346:f151Google Scholar
68Sullivan, FM, Swan, IRC, Donnan, PT, Morrison, JM, Smith, BH, McKinstry, B et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med 2007;357:1598–607Google Scholar
69Engström, M, Berg, T, Stjernquist-Desatnik, A, Axelsson, S, Pitkaranta, A, Hultcrantz, M et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol 2008;7:993–1000Google Scholar
70Minnerop, M, Herbst, M, Fimmers, R, Kaabar, P, Matz, B, Klockgelter, T et al. Bell's palsy; combined treatment of famciclovir and prednisone is superior to prednisone alone. J Neurol 2008;255:1726–30Google Scholar
71Lee, HY, Byun, JY, Park, MS, Yeo, SG. Steroid-antiviral treatment improves the recovery rate in patients with severe Bell's palsy. Am J Med 2013;126:336–4172Google Scholar
72Van der Veen, EL, Rovers, MM, De Ru, JA, Van der Heijden, GJ. A small effect of adding antiviral agents in treating patients with severe Bell palsy. Otolaryngol Head Neck Surg 2012;146:353–7Google Scholar
73Axelsson, S, Berg, T, Jonsson, L, Engström, M, Kanerva, M, Stjernquist-Desatnik, A. Bell's palsy – the effect of prednisolone and/or valaciclovir versus placebo in relation to baseline severity in a randomised controlled trial. Clin Otolaryngol 2012;37:283–90Google Scholar
74De Ru, JA. Re: The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis (Rapid response to Quant et al., 1 June 2013). BMJ 2009;339:b3354Google Scholar
75Ahangar, AA, Hosseini, S, Saghebi, R. Comparison of the efficacy of prednisolone versus prednisolone and acyclovir in the treatment of Bell's palsy. Neurosciences (Riyadh) 2006;11:256–9Google Scholar
76De Ru, JA, Blackburn, TK, McAlister, K, Brennan, PA, Featherstone, C, Van der Veen, EL. Valaciclovir in combination with prednisolone for Bell's palsy. Clin Otolaryngol 2014;39:321–22CrossRefGoogle ScholarPubMed
77Hill, AB. The environment and disease: association or causation? Proc R Soc Med 1965;58:295–300Google ScholarPubMed
78Davenport, RJ, Sullivan, F, Smith, B, Morrison, J, McKinstry, B. Treatment for Bell's palsy. Lancet 2008;372:1219–20Google Scholar
79Lockhart, P, Daly, F, Pitkethly, M, Comerford, N, Sullivan, F. Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev 2009;(4):CD001869Google Scholar
80De Almeida, JR, Al Khabori, M, Guyatt, GH, Witterick, IJ, Lin, VYW, Nedzelski, JM et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA 2009;302:985–93Google Scholar
81Goudakos, JK, Markou, KD. Corticosteroids versus corticosteroids plus antiviral agents in the treatment of Bell palsy: a systematic review and meta-analysis. Arch Otolaryngol Head Neck Surg 2009;135:558–64Google Scholar
82Numthavaj, P, Thakkinstian, A, Dejthevaporn, C, Attia, J. Corticosteroid and antiviral therapy for Bell's palsy: a network meta-analysis. BMC Neurol 2011;11:1Google Scholar
83Ramsey, MJ, DerSimonian, R, Holtel, MR, Burgess, LPA. Corticosteroid treatment for idiopathic facial nerve paralysis: a meta-analysis. Laryngoscope 2000;110:335–41Google Scholar
84Jongkees, LBW. Surgery of the facial nerve. J Laryngol Otol 1968;82:575–84Google Scholar
85Huizing, EH, Mechelse, K, Staal, A. Treatment of Bell's palsy: an analysis of the available studies. Acta Otolaryngol 1981;92:115–21Google Scholar
86Yanagihara, N, Hato, N, Murakami, S, Honda, N. Transmastoid decompression as a treatment of Bell palsy. Otolaryngol Head Neck Surg 2001;124:282–6Google Scholar
87Jongkees, LB. The timing of surgery in intratemporal facial paralysis. Laryngoscope 1969;79:1557–61Google Scholar
88Hopp, ES, Hambley, WM. Bell's palsy. A ten-year review of cases at the University of California Medical Center. Laryngoscope 1961;71:823–9Google Scholar
89Yanagihara, N, Gyo, K, Yumoto, E, Tamaki, M. Transmastoid decompression of the facial nerve in Bell's palsy. Arch Otolaryngol 1979;105:530–4CrossRefGoogle ScholarPubMed
90Alford, BR, Sessions, RB, Weber, SC. Indications for surgical decompression of the facial nerve. Laryngoscope 1971;81:620–35Google Scholar
91Glaziou, P, Chalmers, I, Rawlins, M, McCulloch, P. When are randomised trials unnecessary? Picking signal from noise. BMJ 2007;334:349–51Google Scholar
92Sinha, PK, Keith, RW, Pensak, ML. Predictability of recovery from Bell's palsy using evoked electromyography. Am J Otol 1994;15:769–71Google Scholar
93Mechelse, K, Goor, G, Huizing, EH, Hammelburg, E, van Bolhuis, AH, Staal, A et al. Bell's palsy: prognostic criteria and evaluation of surgical decompression. Lancet 1971;2:57–9CrossRefGoogle ScholarPubMed
94Adour, KK. Decompression for Bell's palsy: why I don't do it. Eur Arch Otorhinolaryngol 2002;259:40–7Google Scholar
95Hato, N, Nota, J, Komobuchi, H, Teraoka, M, Yamada, H, Gyo, K et al. Facial nerve decompression surgery using bFGF-impregnated biodegradable gelatin hydrogel in patients with Bell's palsy. Otolaryngol Head Neck Surg 2012;146:641–6Google Scholar
96Cannon, RB, Gurgel, RK, Warren, FM, Shelton, C. Facial nerve outcomes after middle fossa decompression for Bell's palsy. Otol Neurol 2014. Epub 2014 Jul 23Google Scholar
97Fish, U, Esslen, E. Total intratemporal exposure of the facial nerve. Arch Otolaryngol 1972;95:335–41Google Scholar
98May, M, Klein, SR, Taylor, FH. Idiopathic (Bell's) facial palsy: natural history defies steroid or surgical treatment. Laryngoscope 1985;95:406–9Google Scholar