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JKM > Volume 43(2); 2022 > Article
Kim, Choi, Cha, Lee, Jang, Kim, Jeon, and Kim: Clinical study on recurrent Bell’s palsy: A retrospective observational study

Abstract

Objectives

This study is designed to statistically analyze characteristics, treatment effect and prognosis of patients who were treated for the recurrent Bell’s palsy

Methods

This study retrospectively analyzed the medical records and telephone questionnaire of 82 patients treated with the recurrent Bell’s palsy at the OO Korean Medicine hospital from August 01, 2018 to July 31, 2021.

Results

The lower the EQ-VAS® and HB scale before and after treatment, the higher the satisfaction with the treatment. The average of the number of days and duration of outpatient treatment for male was longer than that for female. The average number of days and duration of outpatient treatment in the group that received combined treatment was longer than that of patients who received Korean Medicine only. The higher the satisfaction of treatment, the higher the willingness to receive treatment in the event of recurrent facial palsy. HB scale after treatment was the lowest in their 40s, and the average value of HB scale after treatment tended to increase as age increased except for those in their 40s.

Conclusion

This study showed that the lower the HB scale after treatment, the lower the EQ-VAS®, the higher the treatment satisfaction, and the higher the probability receiving treatment if the facial paralysis recurs. Those in their 10s to 40s showed excellent results after treatment. Comparatively, those in their 50s and above showed a little effect after treatment. Gender, affected side, history of facial palsy, season of onset, age, hypertension and diabetes had no statistically significance with recurrent Bell’s palsy prognosis.

Fig. 1
Study flow chart
jkm-43-2-8f1.gif
Fig. 2
HB scale before and after treatment
jkm-43-2-8f2.gif
Fig. 3
Adjusted HB scale after treatment
jkm-43-2-8f3.gif
Table 1
Frequency Analysis of Demographic Variables
Variables N %
Sex Male 42 51.2
Female 40 48.8

Age 1–29 6 7.3
30–39 9 11
40–49 12 14.6
50–59 20 24.4
60–69 21 25.6
70- 14 17.7

Mean±SD 54.71±15.675

Time of onset Mar–May 21 25.6
Jun–Aug 17 20.7
Sep–Nov 24 29.3
Dec–Feb 20 24.4

SD: Standard Deviation

Table 2
Frequency Analysis of Disease Variables
Variables N %
Affected side Right 41 50
Left 41 50

Recurred side Same side 34 41.5
Other side 41 50
Both side 2 2.4
Unknown 5 6.1

Number of recurrences 1 73 89
2 4 4.9
3 3 3.7
4 2 2.4

Underlying disease Hypertension 21 25.6
Diabetes 17 20.7

Associated symptoms Post. auricular pain 43 52.4
Lacrimation 47 57.3
Taste change 24 29.3
Hyperacusis 12 14.6

Initial grade of HB scale Grade II 3 3.7
Grade III 16 19.5
Grade IV 29 35.4
Grade V 32 39
Grade VI 2 2.4

Mean±SD 4.17±1.59

SD: Standard Deviation

HB scale: House-Brackmann scale

Table 3
Frequency analysis of therapeutic variables
Variables Number of patients %
Admission Y 45 45.1
N 37 54.9

Combined treatment Y 67 81.7
N 15 18.3

Combined treatment: Acupuncture, Moxibustion, Physical therapy, steroids, antiviral agents

Table 4
Frequency analysis and descriptive statistics of satisfaction characteristics
Variables N %
HB scale after treatment Grade I 54 65.9
Grade II 15 18.3
Grade III 6 7.3
Grade IV 7 8.5

Mean±SD 1.59±0.955

Satisfaction of treatment 1 2 2.4
2 10 12.6
3 9 11
4 25 30.5
5 36 43.9

Mean±SD 4.01±1.128

Intention to receive treatment in case of recurrence Y 66 80.5
N 16 19.5

Presence of sequelae Y 39 47.6
N 43 52.4

Type of sequelae Self-conscious discomfort 19 23.2
Contracture 12 14.6
Synkinesis 3 3.7
Bogorad syndrome 3 3.7
Spasm 2 2.4

SD: Standard Deviation

HB–scale: House-Brackmann scale

Table 5
ANOVA of HB scale after treatment and satisfaction of treatment
Variables Score HB scale after treatment F P

Mean SD
Satisfaction of treatment 1 4 d .000 18.370 0.000***
2 2.50 c 1.434
3 2.22 bc .833
4 1.64 ab .757
5 1.00 a .000

*** p < 0.001

SD: Standard Deviation

HB scale: House-Brackmann scale

Table 6
ANOVA of EQ-VAS® and satisfaction of treatment
Variables Score EQ-VAS® F P

Mean SD
Satisfaction of treatment 1 100 c .000 37.924 0.000***
2 39.50 b 37.524
3 32.22 b 10.639
4 16.20 a 8.327
5 0.69 a 2.436

*** p < 0.001

SD: Standard Deviation

EQ-VAS®: Reversed EuroQol Visual Analogue Scale

Table 7
Multiple linear regression analysis of discharge satisfaction of treatment
Categories Unstandardized Standardized T P F (p-value)
B S.E beta
Independent Variables Constant 5.605 0.388 14.460 0.000 26.318 (.000***)
Number of days of outpatient treatment 0.009 0.008 0.172 1.153 0.253
Outpatient treatment period −0.002 0.002 −0.216 −1.452 0.151
EQ-VAS® −0.030 0.005 −0.635 −5.524 0.000***
HB scale after treatment −0.175 0.140 −0.148 −1.247 0.216
HB scale before treatment −0.195 0.092 −0.156 −2.114 0.038*
Dependent variable: Satisfaction of treatment

*** p<0.001,

* p<0.05

HB scale: House-Brackmann scale

EQ-VAS®: Reversed EuroQol Visual Analogue Scale

Table 8
Logistics regression analysis of intention to receive treatment in case of recurrence
Variable B S.E Wald p Exp(B)
Age 0.013 0.039 0.108 0.742 1.013
Number of days of outpatient treatment 1.827 1.455 1.578 0.209 6.216
Number of days in hospital −0.025 0.048 0.270 0.603 0.975
Outpatient treatment period 0.011 0.011 0.932 0.334 1.011
EQ-VAS® −0.023 0.028 0.667 0.414 0.977
Satisfaction of treatment −3.592 1.112 10.430 0.001** 0.028
Dependent variable: Intention to receive treatment in case of recurrence

** p<0.01

S.E: Standard Error

EQ-VAS®: Reversed EuroQol Visual Analogue Scale

Table 9
Independent T-test of difference between sex and number of days of outpatient treatment and outpatient treatment period
Variables Sex N Mean SD F P
Number of days of outpatient treatment M 48 18.79 23.892 3.449 0.025*
F 48 9.48 15.039 2.171

Outpatient treatment period M 48 77.04 112.427 16.227 0.041*
F 48 38.44 63.341 9.142

Number of days in hospital M 22 14.5 9.551 2.036 0.699
F 29 15.55 9.557 1.775

* p<0.05

SD: standard Deviation

Table 10
Independent T-test of difference between combined treatment and number of days of outpatient treatment and outpatient treatment period
Variables Combined treatment N Mean SD F P
Number of days of outpatient treatment Y 77 22.090 2.517 3.449 0.024*
N 19 4.74 4.483 1.028

Outpatient treatment period Y 77 67.55 100.308 11.431 0.036*
N 19 18 30.092 6.904

* p<0.05

Table 11
ANCOVA of HB scale after treatment and age
Age Adjusted Mean S.E 95% CI Type III SS F-value (p-value)
Min Max
1–29 1.337a .375 .591 2.084 11.479 2.914 (0.019*)
30–39 1.389a .297 .796 1.981
40–49 1.084a .256 .574 1.595
50–59 1.694a .198 1.299 2.089
60–69 2.129a .194 1.743 2.515
70- 1.277a .237 .804 1.749

* p<0.05

S.E: Standard Error

CI: Confidence Interval

Type III SS: Type III sum of squares

Table 12
ANCOVA of HB scale after treatment and age 1 to 69
Age Adjusted Mean SE 95% CI Type III SS F-value (p-value)
Min Max
1–29 1.313a .385 .543 2.082 9.942 3.014 (0.024*)
30–39 1.395a .305 .783 2.004
40–49 1.082a .262 .558 1.606
50–59 1.693a .203 1.287 2.099
60–69 2.129a .198 1.733 2.526

* p<0.05

S.E: Standard Error

CI: Confidence Interval

Type III SS: Type III sum of squares

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