Rim Hwa Sung, Byun Jae Yong, Kim Sang Hoon, Yeo Seung Geun
Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea.
J Clin Med. 2023 Dec 21;13(1):51. doi: 10.3390/jcm13010051.
The optimal treatment approach for patients with Bell's palsy, a condition characterized by acute facial nerve palsy, remains unclear. The present study was designed to provide insights into the most effective treatment strategies, whether steroids alone or steroids plus antiviral agents, as well as the optimal timing of treatment initiation.
To investigate the impact of treatment modalities and timing on the recovery rates of Bell's palsy patients and to assess the roles of individual factors.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective analysis included 1504 patients with Bell's palsy who visited Kyung Hee University Hospital. Patients were divided based on the treatment modality (steroid monotherapy vs. combined steroid and antiviral therapy) and the timing of treatment initiation (≤72 vs. >72 h).
The primary outcome was the recovery rate, as assessed by the House-Brackmann (HB) grade. Secondary outcomes included factors such as age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions.
A combined comparison of patients treated with steroids plus antivirals and steroids alone, stratified by treatment start time, showed that recovery rates were highest in patients who received steroid monotherapy initiated within 72 h (OR 2.36; < 0.05). Patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 h. The recovery rate was higher in patients who received steroid monotherapy than combined therapy (86.32% vs. 79.25%, < 0.05). Initiating treatment beyond 72 h was associated with a higher recovery rate than starting treatment within 72 h (85.69% vs. 76.92%, < 0.05). An evaluation of the factors affecting recovery showed that patients aged 20 to 39 years had a higher recovery rate than other age groups (OR 1.47; < 0.05). Fairly predictive EMG results were associated with significantly higher recovery rates (OR 3.52; < 0.05).
These findings underscore the importance of individualized treatment approaches in Bell's palsy management. Steroid monotherapy remains effective, although combined treatment may have potential advantages, especially in patients with more severe disease. The best treatment results were achieved when steroid treatment was administered within 72 h. Our results suggest that there may be more flexibility in the application of the 72 h treatment period if we consider the time of treatment initiation alone, but this should take into account patient behavior patterns and the limitations of retrospective analysis. Further research is warranted to validate these findings and refine treatment recommendations for patients with Bell's palsy.
贝尔麻痹患者的最佳治疗方法仍不明确，该病症以急性面神经麻痹为特征。本研究旨在深入了解最有效的治疗策略，即单独使用类固醇还是类固醇加抗病毒药物，以及治疗开始的最佳时机。
探讨治疗方式和时机对贝尔麻痹患者恢复率的影响，并评估个体因素的作用。
设计、设置和参与者：这项回顾性分析纳入了1504名就诊于庆熙大学医院的贝尔麻痹患者。患者根据治疗方式（类固醇单一疗法与类固醇联合抗病毒疗法）和治疗开始时间（≤72小时与>72小时）进行分组。
主要结局是恢复率，通过House-Brackmann（HB）分级评估。次要结局包括年龄、神经电图（ENoG）和肌电图（EMG）结果以及合并症等因素。
按治疗开始时间分层，对接受类固醇加抗病毒药物治疗和单独接受类固醇治疗的患者进行联合比较，结果显示，在72小时内开始接受类固醇单一疗法的患者恢复率最高（比值比2.36；<0.05）。重度贝尔麻痹患者在72小时内开始治疗时，联合治疗往往更有益。接受类固醇单一疗法的患者恢复率高于联合治疗（86.32%对79.25%，<0.05）。在72小时后开始治疗的患者恢复率高于在72小时内开始治疗的患者（85.69%对76.92%，<0.05）。对影响恢复的因素进行评估显示，20至39岁的患者恢复率高于其他年龄组（比值比1.47；<0.05）。相当具有预测性的EMG结果与显著更高的恢复率相关（比值比3.52；<0.05）。
这些发现强调了在贝尔麻痹管理中采用个体化治疗方法的重要性。类固醇单一疗法仍然有效，尽管联合治疗可能具有潜在优势，特别是对于病情更严重的患者。在72小时内给予类固醇治疗可取得最佳治疗效果。我们的结果表明，如果仅考虑治疗开始时间，在应用72小时治疗期时可能有更大的灵活性，但这应考虑患者的行为模式和回顾性分析的局限性。有必要进行进一步研究以验证这些发现并完善贝尔麻痹患者的治疗建议。
