| 저자 |
Yong Kim, M.D.1†, Hee-Sang Kim M.D.1, Jong Ha Lee M.D.1, Dong Hwan Yun M.D.1, Jinmann Chon M.D.1, Seung Don Yoo M.D.1, Dong Hwan Kim M.D.1, Seung Ah Lee M.D.1, Yun Soo Soh M.D.1, Young Rok Han M.D.1, Myung Chul Yoo M.D.1, Seung Geun Yeo M.D.2, Seona Chae M.D.1* |
Background: Bell's palsy is an acute, unilateral, peripheral facial nerve paralysis of unknown cause with incidence of 20-30 per 100,000 population. Although Bell’s palsy is a disease with a relatively good prognosis, approximately 10-29% of affected patients develop persistent facial nerve dysfunction. It is important to identify and treat patients at high risk of poor long-term outcomes in order to reduce the risk of persistent facial nerve dysfunction and psychological distress. There is a consensus that early use of steroids is effective for the treatment of Bell's palsy, however, the effectiveness of combination therapy of steroid plus antiviral agents is still controversial. This study aimed to evaluate the therapeutic effect of combination therapy in severe Bell's palsy patients, and to investigate the specific conditions for which combination therapy may have a better therapeutic effect than steroid alone treatment.
Method: We retrospectively reviewed 1710 patients with Bell's palsy who visited the Kyung Hee University Hospital between January 2005 and December 2017. Of these, 335 patients with severe Bell's palsy (defined as initial House-Brackmann (H-B) grade 5, 6) were divided into two groups. 162 patients were treated with steroid alone, while 173 patients received combination therapy with steroid plus antiviral agents. Outcomes were measured using the House-Brackmann (H-B) grade according to age, sex, hypertension, diabetes, and obesity. The H-B grade of facial palsy was followed for more than 6 months until full recovery was achieved. A favorable recovery was defined by a final H-B grade of 1 or 2, and H-B grade ≥ 3 was defined as an unfavorable recovery.
Results: There was significant difference in the rate of favorable recovery (H-B grade 1 or 2) between the combination therapy group and the steroid alone group (78.0% vs. 66.7%, p=0.020) in patients with severe Bell's palsy. Combination therapy group showed significantly higher recovery rate than steroid alone group in patients 40 years or older (77.5% vs. 64.1%, p=0.023), and in patients without hypertension (75.8% vs. 63.3%, p=0.044) or diabetes (79.7% vs. 65.5%, p=0.007). Combination therapy increased the odds ratio for favorable recovery in patients 40 years or older, (OR, 1.93; 95% CI, 1.09-3.42), and in patients without hypertension (OR, 1.82; 95% CI, 1.01-3.27) or diabetes (OR, 2.07; 95% CI, 1.21-3.54).
Conclusion: Combination therapy with steroid plus antiviral agents resulted in significantly higher favorable recovery rates than steroid alone in patients with severe Bell's palsy. Particularly, combination therapy in severe palsy showed a better therapeutic effect than steroid alone in patients 40 years or older, and in patients without hypertension or diabetes. |
