Sang Hoon Kim

Importance: The optimal treatment approach for patients with Bell’s palsy, a condition characterized by acute facial nerve palsy, remains unclear. The present study was designed to provide insights into the most effective treatment strategies, whether steroids alone or steroids plus antiviral agents, as well as the optimal timing of treatment initiation. Objective: To investigate the impact of treatment modalities and timing on the recovery rates of Bell’s palsy patients and to assess the roles of individual factors. Design, Setting, and Participants: This retrospective analysis included 1504 patients with Bell’s palsy who visited Kyung Hee University Hospital. Patients were divided based on the treatment modality (steroid monotherapy vs. combined steroid and antiviral therapy) and the timing of treatment initiation (≤72 vs. >72 h). Main Outcomes and Measures: The primary outcome was the recovery rate, as assessed by the House–Brackmann (HB) grade. Secondary outcomes included factors such as age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions. Results: A combined comparison of patients treated with steroids plus antivirals and steroids alone, stratified by treatment start time, showed that recovery rates were highest in patients who received steroid monotherapy initiated within 72 h (OR 2.36; p < 0.05). Patients with severe Bell’s palsy tended to benefit more from combined therapy when treatment was initiated within 72 h. The recovery rate was higher in patients who received steroid monotherapy than combined therapy (86.32% vs. 79.25%, p < 0.05). Initiating treatment beyond 72 h was associated with a higher recovery rate than starting treatment within 72 h (85.69% vs. 76.92%, p < 0.05). An evaluation of the factors affecting recovery showed that patients aged 20 to 39 years had a higher recovery rate than other age groups (OR 1.47; p < 0.05). Fairly predictive EMG results were associated with significantly higher recovery rates (OR 3.52; p < 0.05). Conclusions: These findings underscore the importance of individualized treatment approaches in Bell’s palsy management. Steroid monotherapy remains effective, although combined treatment may have potential advantages, especially in patients with more severe disease. The best treatment results were achieved when steroid treatment was administered within 72 h. Our results suggest that there may be more flexibility in the application of the 72 h treatment period if we consider the time of treatment initiation alone, but this should take into account patient behavior patterns and the limitations of retrospective analysis. Further research is warranted to validate these findings and refine treatment recommendations for patients with Bell’s palsy.

This study aimed to analyze the clinical characteristics and treatment prognoses of patients with Herpes Zoster Oticus (HZO) and concurrent hearing loss (HL). Various clinical characteristics of 192 patients with HZO, with or without concurrent HL, from 2016 to 2020 were retrospectively analyzed through a chart review. All patients were followed-up until recovery or up to 12 months. Demographic and clinical findings were compared between the groups, and the recovery rates of facial palsy, hearing, and other clinical features were analyzed. Facial palsy recovery was analyzed using the House–Brackmann (HB) grading system, and hearing recovery rates were analyzed using the Siegel criteria. Of the 192 patients diagnosed with HZO, 142 had no hearing loss (HZO without HL), and 50 had hearing loss (HZO with HL). While both groups had similar ages, treatment timings, and underlying diseases, the HZO w HL group had a significantly higher rate of dizziness and tinnitus, but received more intratympanic steroid injections. In terms of facial palsy, there were no significant differences in the initial HB grade or recovery rates between the groups. Within the HZO w HL group, hearing loss severity varied, with 52% experiencing mild loss and only 16% achieving complete recovery. Descending-type audiograms were the most common at 66%. In patients with HZO, there was no statistically significant difference between the degree of initial facial paralysis and the degree of recovery of the final facial paralysis according to concurrent HL. However, among patients with concurrent HL, the hearing recovery rate in the HZO group was low.