Clinical study on recurrent Bell’s palsy: A retrospective observational study

Min Ju Kim; Hyeon Kyu Choi; Hyun Ji Cha; Young Rok Lee; Hyun jin Jang; So jeong Kim; Ju Hyun Jeon; Young Il Kim; Kim, Min Ju; Choi, Hyeon Kyu; Cha, Hyun Ji; Lee, Young Rok; Jang, Hyun jin; Kim, So jeong; Jeon, Ju Hyun; Kim, Young Il

doi:10.13048/jkm.22016

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

Original Article

The Journal of Korean Medicine 2022; 43(2): 8-26.

Published online: June 1, 2022

DOI: https://doi.org/10.13048/jkm.22016

Clinical study on recurrent Bell’s palsy: A retrospective observational study

, Hyun Ji Cha

, Young Il Kim^*

Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea

Correspondence to: Young Il Kim, Daedeok-daero 176beon-gil, Seo-gu, Daejeon, Republic of Korea, Tel: +82-42-470-9137, Fax: +82-42-470-9008, Email: omdkim01@dju.kr

Received March 29, 2022 Revised May 2, 2022 Accepted May 19, 2022

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.

Keywords: Bells palsy, Recurrent facial palsy, Retrospective observational study, Statistical Analysis

Fig. 1

Study flow chart

Fig. 2

HB scale before and after treatment

Fig. 3

Adjusted HB scale after treatment

Table 1

Frequency Analysis of Demographic Variables

Variables		N	%
Sex	Male	42	51.2
Sex	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
Affected side	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
Underlying disease	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
Admission	N	37	54.9

Combined treatment	Y	67	81.7
Combined treatment	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
Intention to receive treatment in case of recurrence	N	16	19.5

Presence of sequelae	Y	39	47.6
Presence of sequelae	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)
Categories		B	S.E	beta	T	P	F (p-value)
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^*
Number of days of outpatient treatment	F	48	9.48	15.039	2.171	0.025^*

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

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

* 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^*
Number of days of outpatient treatment	N	19	4.74	4.483	1.028	0.024^*

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

* 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)
Age	Adjusted Mean	S.E	Min	Max	Type III SS	F-value (p-value)
1–29	1.337^a	.375	.591	2.084	11.479	2.914 (0.019^*)
30–39	1.389^a	.297	.796	1.981
40–49	1.084^a	.256	.574	1.595
50–59	1.694^a	.198	1.299	2.089
60–69	2.129^a	.194	1.743	2.515
70-	1.277^a	.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)
Age	Adjusted Mean	SE	Min	Max	Type III SS	F-value (p-value)
1–29	1.313^a	.385	.543	2.082	9.942	3.014 (0.024^*)
30–39	1.395^a	.305	.783	2.004
40–49	1.082^a	.262	.558	1.606
50–59	1.693^a	.203	1.287	2.099
60–69	2.129^a	.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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