Evaluation of Factors Associated With Favorable Outcomes in Adults With Bell Palsy

Abstract

This cohort study examines the factors that are associated with the favorable outcomes, defined as a House-Brackmann grade of II or lower, in patients treated for Bell palsy.

Key Points

Question

Which factors are associated with improved outcomes in patients with Bell palsy?

Findings

In this cohort study of 1364 patients diagnosed with Bell palsy between 2005 and 2017, factors that were associated with improved facial function included younger age, a lower degree of initial facial nerve paralysis as measured using the House-Brackmann grade, good electromyography result (absence of pathological spontaneous fibrillation activity), absence of diabetes, and control of hypertension.

Meaning

The findings of this study suggest that multiple clinical factors may be associated with a favorable outcome in patients with Bell palsy.

Abstract

Importance

Identification of the factors associated with improved facial nerve function after treatment of Bell palsy is important to provide patients with early and effective treatment.

Objective

To identify factors that are associated with improved treatment outcomes in patients with Bell palsy.

Design, Setting, and Participants

This retrospective cohort study included 1364 patients with Bell palsy treated at the outpatient clinic of the Department of Otolaryngology at the Kyung Hee University Hospital, Seoul, Republic of Korea, between January 1, 2005, and December 31, 2017. The medical records of patients admitted to this hospital for management of acute facial palsy were reviewed by 3 otolaryngologists with more than 20 years’ experience in treating facial palsy.

Main Outcomes and Measures

Facial function at the initial and final visits were measured using the House-Brackmann (H-B) grading system, which is one of several analysis tools developed to quantify facial function and provide reproducible information. It is a widely accepted system for grading facial function in 6 steps, from normal (H-B grade I) to total paralysis (H-B grade VI).

Results

In total, 1364 patients with primary Bell palsy (718 [52.6%] women) and a mean (SD) age of 47.7 (16.7) years were enrolled. The overall rate of favorable outcome, which was defined as an H-B grade of I or II at the 6-month follow-up visit, was 80.6% (1099 of 1364 patients). Of 1099 patients who had a favorable outcome at 6 months, 343 (31.2%) were younger than 40 years. Of 1364 patients, 1053 (77.2%) had moderate facial dysfunction (H-B grade III or IV). No pathological spontaneous fibrillation activity (ie, good electromyography [EMG] results) was detected on EMG in 937 of 1364 patients (68.7%), 492 (36.1%) had controlled hypertension, and 673 (49.3%) were treated with oral corticosteroids alone. Multivariable analysis revealed that the following factors were associated with favorable outcome: age younger than 40 years (odds ratio [OR], 1.56; 95% CI, 1.09-2.22), an initial H-B grade of III or IV (OR, 2.62; 95% CI, 1.93-3.57), good EMG results after 2 weeks of treatment (OR, 3.38; 95% CI, 2.48-4.61), absence of diabetes (OR, 1.43; 95% CI, 1.04-2.36), and control of hypertension (OR, 1.64; 95% CI, 1.16-2.33).

Conclusions and Relevance

Multiple logistic regression analysis in this study suggests that multiple clinical factors are associated with favorable outcomes in patients with Bell palsy.