Hyperbaric oxygen therapy for Bell's palsy

  • Review
  • Intervention

Authors


Abstract

Background

Bell's palsy is an idiopathic, acute unilateral facial weakness that evolves rapidly and is maximal within two days. Moderate ear discomfort, sensitivity to sound and reduced tearing may occur.

Objectives

To assess the effects of hyperbaric oxygen therapy on recovery of facial function in adults with moderate to severe Bell's palsy.

Search methods

We searched the Cochrane Neuromuscular Disease Group Specialized Register (January 2012), CENTRAL (2011, Issue 4), MEDLINE (January 1966 to January 2012), EMBASE (January 1980 to January 2012), CINAHL (1937 to January 2012), AMED (1985 to January 2012), LILACS (January 1982 to January 2012). In addition we made a systematic search for relevant controlled trials in specific hyperbaric literature sources.

Selection criteria

Randomised controlled trials or quasi-randomised controlled trials of adults (over 16 years of age) undergoing hyperbaric oxygen therapy for moderate to severe Bell's palsy. We considered studies to be of sufficient quality for inclusion in the review only if there was blinding in the assessment of the facial palsy grade. We planned to include studies of HBOT used as adjuvant therapy, or in addition to routine medical therapy (including corticosteroids or antivirals, or both). Both treatment and control groups were to receive the same baseline therapy. HBOT had to be delivered at concentrations greater than or equal to 1.2 ATA in a hyperbaric oxygen chamber as a series of dives of 30 to 120 minutes.

Data collection and analysis

Two reviewers independently assessed eligibility and study quality and extracted data. We contacted study authors for additional information.

Main results

Our searches found no randomised controlled trials or quasi-randomised controlled trials that met the eligibility criteria for this review.

There is very low quality evidence from one randomised trial involving 79 participants with acute Bell's palsy, but this study was excluded as the outcome assessor was not blinded to treatment allocation and thus did not meet pre-defined eligibility criteria. The trial compared 42 people who received hyperbaric oxygen therapy (2.8 atmospheres for 60 minutes twice daily, five days per week until the facial palsy resolved; maximum 30 'dives') and placebo tablets with 37 people who received placebo hyperbaric oxygen therapy (achieving only a normal partial pressure of oxygen) and prednisone (40 mg twice daily, reducing over eight days). Facial function recovered in more participants treated with hyperbaric oxygen therapy than with prednisone (hyperbaric oxygen therapy, 40/42 (95%); prednisone, 28/37 (76%); risk ratio 1.26, 95% CI 1.04 to 1.53). There were no reported major complications and all participants completed the trial.

Authors' conclusions

Very low quality evidence from one trial suggests that hyperbaric oxygen therapy may be an effective treatment for moderate to severe Bell's palsy, but this study was excluded as the outcome assessor was not blinded to treatment allocation. Further randomised controlled trials are needed.

Plain language summary

High pressure (hyperbaric) oxygen therapy for Bell's palsy

Bell's palsy is a weakness of one side of the face that is diagnosed after other causes of facial weakness have been ruled out. It is a 'diagnosis of exclusion'. Bell's palsy may be caused by a virus affecting the facial nerve. Standard treatment includes steroids to help settle swelling of the facial nerve, whereas antiviral treatment does not appear to help. In hyperbaric oxygen therapy, the person undergoing treatment breathes 100% oxygen in a pressurised chamber for about one hour (called a 'dive'). This may produce more dissolved oxygen in the facial nerve and might reduce nerve damage in Bell's palsy. We searched for evidence from randomised controlled trials on hyperbaric oxygen therapy in adults with moderate to severe Bell's palsy. Our searches revealed no trials that met the inclusion criteria for the review. We found very low quality evidence from one trial to suggest that hyperbaric oxygen therapy might be beneficial for moderate to severe Bell's palsy. The trial involved 79 participants and compared hyperbaric oxygen therapy to prednisone, a corticosteroid, which is a proven active treatment. The participants did not know which treatment they were being given. Those treated with hyperbaric oxygen recovered more quickly and recovered normal facial movement more often (95% versus 76%). All participants tolerated the treatment well, and there were no major complications. The quality of evidence from this trial was very low because the assessors of facial function were aware of which treatment each participant had been given, which introduces a high risk of bias. There is therefore no high quality evidence on which to base conclusions about the efficacy of hyperbaric oxygen therapy in Bell's palsy.

Laienverständliche Zusammenfassung

Hochdruck (hyperbare) Sauerstoff-Therapie bei Fazialisparese (Bell-Lähmung)

Fazialisparese (Bell-Lähmung) ist eine Schwäche einer Seite des Gesichts, die diagnostiziert wird, nachdem andere Ursachen von Gesichtschwäche ausgeschlossen worden sind. Es ist ein "Ausschlussdiagnose". Eine Fazialisparese (Bell-Lähmung) kann durch einen Virus verursacht sein, der die Gesichtsnerven beeinträchtigt. Die Standard-Behandlung umfasst Steroide, um eine Schwellung des Gesichtsnervs in den Griff zu bekommen, wohingegen eine antivirale Therapie nicht zu helfen scheint. Bei einer hyperbaren Sauerstoff-Therapie, atmet die behandelte Person 100% Sauerstoff in einer Druckkammer für etwa eine Stunde (eine so genannte "Sitzung"). Die Therapie kann evtl. mehr gelösten Sauerstoff im Gesichtsnerven bereitstellen und könnte Nervenschäden bei Fazialisparese (Bell-Lähmung) reduzieren. Wir suchten nach Evidenz aus randomisierten kontrollierten Studien zur hyperbaren Sauerstoff-Therapie bei Erwachsenen mit moderater bis schwerer Fazialisparese (Bell-Lähmung). Unsere Suche konnte keine Studien, welche die Einschlusskriterien für diesen Review erfüllten, identifizieren. Wir fanden Evidenz von sehr geringer Qualität aus einer Studie, die Hinweise liefert, dass hyperbare Sauerstoff-Therapie nützlich sein kann bei moderater bis schwerer Fazialisparese (Bell-Lähmung). An der Studie nahmen 79 Teilnehmer teil und sie verglich hyperbare Sauerstoff-Therapie mit Prednison, einem Kortikosteroid, welches eine gesicherte aktive Behandlung darstellt. Die Teilnehmer wussten nicht, welche Behandlung sie erhielten. Diejenigen, die mit hyperbarer Sauerstoff-Therapie behandelt wurden, erholten sich schneller und die Gesichtsfunktion erholte sich auch häufiger (95% versus 76%). Alle Teilnehmer vertrugen die Behandlung gut, und es gab keine größeren Komplikationen. Die Qualität der Evidenz aus dieser Studie war sehr niedrig, da die Bewerter der Gesichtsfunktion wussten, welche Behandlung jeder Teilnehmer bekommen hatte; dies bedingt ein hohes Verzerrungsrisiko. Aus diesem Grund gibt es keine Evidenz hoher Qualität, auf der Schlussfolgerungen über die Wirksamkeit der hyperbaren Sauerstoff-Therapie bei Fazialisparese (Bell-Lähmung) gründen können.

Anmerkungen zur Übersetzung

I. Toews, freigegeben durch Cochrane Deutschland.

Laički sažetak

Hiperbarična (pod povišenim tlakom) terapija kisikom za Bellovu parezu

Bellova pareza (paraliza, kljenut) je slabost jedne strane lica koja se dijagnosticira nakon što se isključe drugi uzroci slabosti lica. To je dijagnoza koja se postavlja isključivanjem drugih mogućih uzroka poremećaja. Bellova pareza može biti uzrokovana virusom koji pogađa facijalni (lični) živac. Standardna terapija uključuje steroide kako bi se smanjilo oticanje facijalnog živca, a antivirusno liječenje naizgled ne pomaže. Kod hiperbarične terapije kisikom, osoba na liječenju udiše 100% kisik u komori pod tlakom tijekom oko jednog sata (što se naziva "uron"). To može dovesti do više otopljenog kisika u facijalnom živcu i moglo bi smanjiti ozljedu živca u Bellovoj parezi. U ovom Cochrane sustavnom pregledu pretraženi su dokazi iz randomiziranih kontroliranih istraživanja hiperbarične terapije kisikom u odraslih s umjerenom do teškom Bellovom parezom. Pretraživanjem nisu pronađene studije koje su odgovarale kriterijima uključenja u ovaj Cochrane sustavni pregled. Pronađeni su dokazi vrlo niske kvalitete iz jednog istraživanja koje sugerira da bi hiperbarična terapija kisikom mogla biti korisna kod umjerene do teške Bellove pareze. Međutim, to istraživanje nije odgovaralo kriterijima uključenja jer su osobe koje su procjenjivale rezultate znale u koju skupinu su ispitanici razvrstani. To istraživanje je uključivalo 79 sudionika i uspoređivalo hiperbaričnu terapiju kisikom s prednizonom, kortikosteroidom koji predstavlja dokazano aktivno liječenje. Sudionici nisu znali koju terapiju primaju. Oni liječeni hiperbaričnim kisikom oporavili su se brže i češće vratili normalne pokrete lica (95% naspram 76%). Svi su sudionici dobro podnosili terapiju, a nije bilo većih komplikacija. Kvaliteta dokaza iz ovog istraživanja je bila vrlo niska jer su istraživači koji su ocjenjivali funkcije lica znali koju je terapiju primio svaki sudionik, što uvodi visoki rizik od pristranosti. Stoga nema dokaza visoke kvalitete na kojima bi se temeljili zaključci o učinkovitosti hiperbarične terapije kisikom u Bellovoj parezi.

Bilješke prijevoda

Cochrane Hrvatska
Prevele: Katarina Vučić i Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

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