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

Article information

J Korean Med. 2022;43(2):8-26
Publication date (electronic) : 2022 June 1
doi : https://doi.org/10.13048/jkm.22016
Min Ju Kimorcid_icon, Hyeon Kyu Choiorcid_icon, Hyun Ji Chaorcid_icon, Young Rok Leeorcid_icon, Hyun jin Jangorcid_icon, So jeong Kimorcid_icon, Ju Hyun Jeonorcid_icon, Young Il Kimorcid_icon
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 2022 March 29; Revised 2022 May 2; Accepted 2022 May 19.

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

Frequency Analysis of Demographic Variables

Frequency Analysis of Disease Variables

Frequency analysis of therapeutic variables

Frequency analysis and descriptive statistics of satisfaction characteristics

ANOVA of HB scale after treatment and satisfaction of treatment

ANOVA of EQ-VAS® and satisfaction of treatment

Multiple linear regression analysis of discharge satisfaction of treatment

Logistics regression analysis of intention to receive treatment in case of recurrence

Independent T-test of difference between sex and number of days of outpatient treatment and outpatient treatment period

Independent T-test of difference between combined treatment and number of days of outpatient treatment and outpatient treatment period

ANCOVA of HB scale after treatment and age

ANCOVA of HB scale after treatment and age 1 to 69

References

1. Jung YS, Jang SY, Shin HCA. Clinical Study about General Characteristics . 2013;Treatment Progress and Obesity-underweight of Idiopathic Facial Paralysis (Bell’s palsy). Korean J Orient Int Med 34(1):86–99.
2. Kim J. 2020. Facial nerve and Facial Paralysis Seoul, Korea: Dhmbook. p. 43–44. p. 74–83.
3. 한국한의학연구원. 2015. Idiopathic Facial Palsy Korean Medicine Clinical Practice Guideline Seoul, Korea: 엘스비어코리아(유).
4. Kang EK, Kim JH, Seo HS. 2009;The clinical investigation studies in peripheral facial paralysis using Needle-embedding therapy. J Korean Med Ophthalmol Otolaryngol Dermatol 22(2):118–27.
5. Lee ES, Jeong JY, Seo DG, Shin SY, Seo JC, Seo YJ, Jang KJ. 2014;Clinical research of cervical acupotomy effects with acupuncture on facial & trigeminal nerve branch on peripheral facial paralysis and postauricular pain. The Acupunct 31(4):143–54.
6. Jeong JY, Lee ES, Seo DG, Shin SY, Kim SY, Kwon HK, Yoon HM. 2014;The clinical research of cervical Chuna treatment’s effects on Bell’s palsy. The Acupunct 31(3):45–55.
7. Park YK, Lee CI, Lee JH, Lee HJ, Lee YK, Seo JC, Kim JS. 2019;A Facial Chuna Manual Therapy for Peripheral Facial Nerve Palsy. Journal of Acupuncture Research 36(4):197–203. https://doi.org/10.13045/jar.2019.00283 .
8. Frequent disease statics Healthcare Bigdata Hub [Internet] 2021. Available from: http://opendata.hira.or.kr/op/opc/olapHifrqSickInfo.do .
9. KAMM. Acupuncture medicine Seoul, Korea: Hanmibook; 2016. p. 656–58.
10. Swami H, Dutta A, Nambiar S. Recurrent Bell’s Palsy. 2010;Medical Journal Armed Forces India 66:95–6. https://doi.org/10.1016/S0377-1237(10)80115-7 .
11. Shin YJ, Kwon NH, Park HA, Woo HS, Beak YH, Park DS, Koh HK. 2009;Clinical Study on Recurrent Peripheral Facial Nerve Palsy. The journal of Korean Acupuncture & Moxibustion Society 26(1):29–37.
12. Lee HI, Shin JB, Lee SJ, Jun PS, Kim KT. 2005;Long-term Follow-up of Idiopathic Facial Palsy. Annals of Rehabilitation Medicine 29(6):602–607.
13. House JW, Brackmann DE. 1985;Facial nerve grading system. Otolaryngology--head and neck surgery: official journal of American Academy of Otolaryngology-Head and Neck Surgery 93(2):146–7. doi:10.1177/019459988509300202.
14. Whynes DK. 2008;Correspondence between EQ-5D health state classifications and EQ VAS scores. Health and quality of life outcomes 6:94. https://doi.org/10.1186/1477-7525-6-94 .
15. Yoo MC, Soh YS, Chon JM, Lee JH, Jung JY, Kim SS, Yeo SG. 2020;Evaluation of actors associated with favorable outcomes in adults with Bell palsy. JAMA Otolaryngol Head Neck Surg 146:256–263. https://doi.org/10.1001/jamaoto.2019.4312 .
16. Heckmann JG, Urban PP, Pitz S, Guntinas-Lichius O, Gágyor I. 2019;The diagnosis and treatment of idiopathic facial paresis (Bell’s palsy). Dtsch Arztebl Int 116:692–702. https://doi.org/10.3238/arztebl.2019.0692 .
17. Gaudin RA, Jowett N, Banks CA, Knox CJ, Hadlock TA. 2016;Bilateral facial paralysis: a 13-year experience. Plast Reconstr Surg 138(4):879–87. https://doi.org/10.1097/PRS.0000000000002599 .
18. Kim MW, KIM J. 2016;Early Stage Steroid Treatment for Acute Facial Paralysis in Korea. Korean J Otorhinolaryngol-Head Neck Surg 59(5):346–52. https://doi.org/10.3342/kjorl-hns.2016.59.5.346 .
19. Yeo SG, Lee YC, Park DC, Cha CI. 2008;Acyclovir plus steroid vs steroid alone in the treatment of Bell’s palsy. American journal of otolaryngology 29(3):163–6. https://doi.org/10.1016/j.amjoto.2007.05.001 .
20. Kim JS, Kim JH, Kim YS, Koh HK, Kang SK, Kim CH. 2000;Cross-sectional Study on Recurrence of Bell’s Palsy. Journal of Acupuncture Research 17(3):69–74.
21. Huh SS, Kim YI. 2021;Review on Clinical Studies of Recurrent Facial Palsy Treatment in Republic of Korea. Journal of Haehwa Medicine 30(1):1–10.
22. Lee JW, Kwon SA, Kim MJ, Song JY, Kim PG, Seo BK, Baek YH. 2011;A Study of Facial Palsy Sequelae and Evaluating Scale. J Korean Acupunct Moxib Soc 28(2):75–87.
23. Kim KJ, Seok JI, Lee DK. 2008;The Clinical Analysis of Recurrent Bell’s Palsy. Annals of Clinical Neurophysiology 10(1):38–42.
24. Dourado GB, Volpato GH, Pedron Oltramari PV, De almeida-pedrin RR, Freire Femandes TM. De castro ferreire conti AC. 2021;Likert scale vs visual analog scale for assessing facial pleasantness. Am J Orthod Dentofacial Orthop 160(6):844–852. https://doi.org/10.1016/j.ajodo.2020.05.024 .
25. Lee YR, Cha HJ, Choi HK, Kim MJ, Kim BS, Sung KJ, Kim YI. 2021;Analysis of Patients Visiting Department of Acupuncture and Moxibustion in Korean Medicine Hospital Before and After COVID-19 - Focusing on a Korean Medicine Hospital in Daejeon. Journal of Korean Medicine 42(2):31–49. https://doi.org/10.13048/jkm.21013 .
26. Jeon SJ, Choi ES, Lee HY. 2010;Gender-related Difference in the Utilization of Health Care Services by Korean Adults. The Journal of Korea Community Health Nursing Academic Society 24(2):182–196. https://doi.org/10.5932/JKPHN.2010.24.2.182 .
27. 대한이과학회. 2010. Seoul, Korea: 급성안면 신경마비 진료지침
28. Park GN, Jeong JK, Kim ES, Kim JH, Kim YI. 2017;Prognostic Factors of Idiopathic Facial Palsy: A Retrospective Study. Journal of Acupuncture Research 34:23–38. https://doi.org/10.13045/acupunct.2017090 .
29. Lee DH, Jun BJ, Lee DH. 2005;Analysis of Prognostic Factors in Bell’s Palsy and Ramsay-Hunt’s Syndrome. Korean J Otolaryngol 48:1081–5. https://doi.org/10.1016/j.anl.2006.09.005 .

Article information Continued

Fig. 1

Fig. 1

Study flow chart

Fig. 2

Fig. 2

HB scale before and after treatment

Fig. 3

Fig. 3

Adjusted HB scale after treatment

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