Bell's Palsy: The Spontaneous Course of 2,500 Peripheral ... - Admin

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Bell’s palsy 9 Fig. 3. Age distribution of patients with Bell’s palsy in comparison with that of the underlying population. Side of the face There was no difference in localization, with 828 (48.7%) right- and 873 (51.3%) left-sided palsies (0.1 BpB0.2). Age distribution This subject has also been debated, without de nitive conclusions having been reached. Figure 3 demonstrates the age distribution of patients with Bell’s palsy in comparison to the age distribution of the underlying population. The incidence of Bell’s palsy reaches a maximum between the ages of 15 and 45 years and this differs highly signi cantly from the age distribution of the underlying population (pB0.001). The disease is signi cantly less common below the age of 15 years and above the age of 60 years (pB 0.001). For the group aged 45–59 years the incidence of Bell’s palsy did not differ signi cantly from the age distribution of the underlying population (p¾0.4). The in uence of age on the incidence of Bell’s palsy would therefore seem to be convincingly demonstrated. Symptoms The most alarming symptom of Bell’s palsy is of course the paresis itself. Approximately 50% of patients believe that they have suffered a stroke, 25% fear an intracranial tumor and the remaining 25% have no clear conception of what is wrong, but are Table VI. Distribution of symptoms of Bell’s palsy among the patient sample Symptom n % Taste disorders 580 34 Phonophobia 234 14 Tear ow 1137 67 Dry eye 69 4 Postauricular pains 881 52 Fig. 4. Distribution of time of beginning recovery after the onset of paresis. extremely anxious. The distribution of symptoms among the patient sample is shown in Table VI. Postauricular pains, which were experienced by almost half the patients, are of the utmost interest. These pains occurred simultaneously with the palsy in :50% of patients, whilst in 25% they occurred 2 or 3 days before the onset of palsy. The remaining 25% of patients experienced pains after the onset of palsy. The pains are located deep in the mastoid region, usually persist for one to several weeks and require analgesia. Every third patient will complain about taste disorders but when examined objectively four out of ve show a reduced sense of taste. This difference can be explained by the fact that patients can still use the normal side of the tongue to taste. Only a few patients are able to perceive restricted stapedius re ex paresis, which may lead to phonophobia or diplaucusis. In comparison, two out of three patients complain about tear ow. However, this is not caused by hypersecretion but by the diminished function of the musculus orbicularis oculi, which prevents tears from being transported medially to the lacrimal sac. Time of beginning recovery Very little interest has been paid in the literature to the question of recovery time and therefore it was felt worthwhile to record the pattern of remission for the idiopathic palsies. The time of the rst sign of muscular movement in relation to the onset of palsy was recorded. Of a total of 1,701 patients, 1,189 suffered from complete paralysis (70%) and 512 from incomplete paralysis (30%). Recovery occurred within 3 weeks for 1,448 patients (85%) and within 3–5 months for the remaining 253 patients (15%). The results are shown in Fig. 4. By de nition, all patients with incomplete paresis have function back at time zero, i.e. at the onset of paresis. In the rst
10 E. Peitersen week 6% of patients achieved remission, in the second week 33% and in the third week 16%. No patients achieved remission between 3 weeks and 3–5 months after the onset of paresis. This is because patients who showed improvement in the rst 3 weeks had only partial degeneration and blocking of nerve conduction whilst patients who showed improvement after 3–5 months had total degeneration. After 3–5 months 10% of patients experienced remission and after 5–6 months an additional 5% experienced remission. This investigation shows that all patients diagnosed with Bell’s palsy achieve some degree of muscular function. However, this does not imply that all patients achieve normal function. The period between the rst 3 weeks without remission and after the third month without remission is one characterized by ‘‘hibernation of the facial nerve’’. Although the nerve seems to be dead it is in fact still alive and in the process of repairing the damage. Complete recovery The next question is naturally how many patients will achieve complete remission? In this study, of a total of 1,701 patients, 1,202 (71%) achieved normal facial nerve function. The second question is how long does it take before patients achieve normal function? Prospects are decidedly better for the group with some remission within the rst 3 weeks (Table VII). Patients with the poorest prognosis are of course those with total degeneration and late return of function. This group does not regain normal mimical function. Normal function is regained as early as within 2 months for the majority (58%) of all patients (Fig. 5). The possibility of normalization is very small after 3 months, at which time 64% of patients have regained normal function, and beyond 6 months no patients regained normal mimical function (Fig. 6). As noted before (Table VII), the incomplete Bell’s palsy patients have a very good prognosis for full recovery (481:512; 94%). Of the patients with complete Bell’s palsy, 721:1,189 (61%) regained normal facial muscle function. The difference between the two groups in terms of the number of patients who Fig. 5. Distribution of time of complete recovery after the onset of paresis. achieved full recovery was highly signi cant (pB 0.001). Gender and recovery The numbers of males and females who experienced full recovery were 564 (69%) and 638 (72%), respectively. There was no statistically signi cant difference between the two groups (p\2). Factors in uencing the nal resuls Time of beginning remission. The number of days between the onset of paresis and the beginning of remission is a very decisive factor in the degree of recovery (Fig. 7). A total of 94% of patients with incomplete paresis regained normal function. Of patients who showed remission in the rst week, 88% regained normal function, as opposed to 83% of those who showed remission in the second week and 61% of those who showed remission in the third week. The prognosis for patients with incomplete paresis was signi cantly better than that for the group who recovered in the rst week (p¾0.03). There was no signi cant difference in prognosis between patients who recovered in the rst and second weeks (p¾0.2) but patients who recovered in the Table VII. Distribution of patients with initial incomplete and complete paresis who make a full recovery from Bell’s palsy Paresis with full recovery Initial n Final % n % Incomplete 512 30 481 94 Complete 1189 70 721 61 Fig. 6. Distribution of time of complete recovery (cumulative) after the onset of paresis.
Page 1 and 2: Acta Otolaryngol 2002; Suppl 549: 4
Page 3 and 4: 6 E. Peitersen Table II. Timetable
Page 5: 8 E. Peitersen Table V. Etiologies
Page 9 and 10: 12 E. Peitersen Table VIII. Results
Page 11 and 12: 14 E. Peitersen Table XI. Compariso
Page 13 and 14: 16 E. Peitersen described. This stu
Page 15 and 16: 18 E. Peitersen Thermal methods In
Page 17 and 18: 20 E. Peitersen cally valid study c
Page 19 and 20: 22 E. Peitersen strated with either
Page 21 and 22: 24 E. Peitersen outcome for patient
Page 23 and 24: 26 E. Peitersen for their accusatio
Page 25 and 26: 28 E. Peitersen The enormous use of
Page 27: 30 E. Peitersen 83. Adour KK, Winge

Bell's Palsy: The Spontaneous Course of 2,500 Peripheral ... - Admin

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