Value of electroneurography as a prognostic indicator for recovery in acute severe inflammatory facial paralysis: A prospective study of bell's palsy and ramsay hunt syndrome

Authors

  • Hayoung Byun MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; and the
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  • Yang-Sun Cho MD, PhD,

    Corresponding author
    • Department of Otorhinolaryngology–Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; and the
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  • Jeon Yeob Jang MD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; and the
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  • Kyu Whan Chung MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea.
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  • Soojin Hwang BA,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; and the
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  • Won-Ho Chung MD, PhD,

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; and the
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  • Sung Hwa Hong MD, PhD

    1. Department of Otorhinolaryngology–Head and Neck Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul; and the
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  • Presented at the 28th Politzer Society Meeting, Athens, Greece, Sep 28–Oct 1, 2011.

  • This work was supported by grant from the Strategic Technology Development Program of Ministry of Knowledge Economy (10031764), and grant of Seoul R&D Program (SS100022). The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Yang-Sun Cho, MD, PhD, Department of Otorhinolaryngology–Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul 135-710, South Korea. E-mail: yscho@skku.edu

Abstract

Objectives/Hypothesis

To evaluate the prognostic and predictive value of electroneuronography (ENoG) in acute severe inflammatory facial paralysis, including Bell's palsy and Ramsay Hunt syndrome (RHS).

Study Design

Prospective observational study.

Methods

Patients with acute severe facial paralysis of House-Brackmann (H-B) grade IV or worse and diagnosed with Bell's palsy or RHS were enrolled from August 2007 to July 2011. After treatment with oral corticosteroid, antiviral agent, and protective eye care, patients were followed up until recovery or 12 months from onset.

Results

Sixty-six patients with Bell's palsy and 22 with RHS were included. Multiple logistic regression analysis showed significant effect of ENoG value on recovery in both Bell's palsy and RHS. Values of ENoG were significantly worse in RHS than Bell's palsy. Chance of early recovery within 6 weeks after correction of ENoG effect was still significantly worse in RHS. Logistic regression analysis showed 90% chance of recovery within 6 months, expected with ENoG values of 69.2% degeneration (Bell's palsy) and 59.3% (RHS). The receiver operating characteristics (ROC) curves showed ENoG values of 82.5% (Bell's palsy) and 78.0% (RHS) as a critical cutoff value of nonrecovery until 1 year, with the best sensitivity and specificity.

Conclusions

A higher chance of recovery was expected with better ENoG in Bell's palsy and RHS. Based on our data, nonrecovery is predicted in patients with ENoG value greater than 82.5% in Bell's palsy, and 78% in RHS.

Level of Evidence

4. Laryngoscope, 123:2526–2532, 2013

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