Therapeutic approach and prognostic factors in Bell´s palsy: retrospective study of five years in a Portuguese hospital

Abstract

Aims: To compare therapeutic approaches (corticosteroids vs. corticosteroids + antivirals, as well as physical therapy) in patients with Bell’s palsy and to investigate potential factors related to its clinical course and prognosis.

Methods: Retrospective study of clinical cases of Bell’s palsy treated at Hospital Garcia de Orta, Almada, Portugal, between 2009 and 2013 (five years). The severity of the initial dysfunction caused by the palsy was assessed using the House-Brackmann scale. Therapeutic approaches and prognostic factors were evaluated based on the rate and time of recovery, and full recovery occurred when a House-Brackmann grade I was observed after therapy. Diabetes mellitus and pregnancy and/or the postpartum period were also evaluated as risk factors for recurrence. Non-parametric tests were used and the significance level was set as p <0.05.

Results: One hundred and eighty cases of Bell’s palsy were recorded throughout the study period, corresponding to an average incidence of 36 cases/year. The main therapeutic approach consisted of the combination of corticosteroids and antivirals in 67.2% of the cases. The full recovery rate with the combination therapy was 65.5% (57 out of 87 patients) vs. 72.4% (21 out of 29 patients) in corticosteroid therapy alone. As to recovery time, 72.4% (63 out of 87 patients) recovered in 3 months with the use of the combination therapy vs. 75.8% (22 out of 29 patients) in those treated with corticosteroids alone. Therefore, no statistical significance between the type of therapy used and recovery rate (p=0.689) or recovery time (p=0.977). Only otalgia and/or dysgeusia was/were statistically associated with the clinical course, showing a lower recovery rate (51.2% vs. 74.4%) (p = 0.004) and longer recovery time (60.5% vs. 79.2% at 3 months) (p = 0.011). There was a statistically significant association of physical therapy with higher recovery rate (p = 0.049). Palsy recurred in 24.1% of the patients with diabetes (7 out of 29) compared with only 6.0% (9 out of 51) among non-diabetic patients (p=0.006).

Conclusions: No significant difference was observed in recovery rate or recovery time among the cases treated with the combined therapy and those treated with corticosteroids alone. Physical therapy was associated with a higher recovery rate. Among the prognostic factors, only otalgia and/or dysgeusia was/were statistically significant, indicating a poor prognosis of Bell’s palsy. The presence of diabetes mellitus proved to be a risk factor for recurrence.