All of the following are true regarding Bells palsy is all except:
Correct Answer: Immediate nerve decompression is required
Description: Ans. d. Immediate nerve decompression is required (Ref: Dhingra 4th/94-95)Immediate nerve decompression is not required in Bell's palsy, initially steroids are given and recovery occurs in 85-90% cases. Nerve decompression relieves pressure on the nerve fibers and improves the microcirculation of nerve, done in non-responding cases.Bell's PalsyBell's palsy is responsible for 60-75% of facial paralysis.Defined as idiopathic, peripheral paralysis or paresis of acute onsetBoth sexes are affected equallyAny age group may be affected though incidence increases with agePositive family history in 6-8% casesIncreased risk of Bell's palsy in diabetics (angiopathy) and pregnant women (retention of fluid)Etiology:Viral Infections:Herpes simplexHerpes zosterEbstein-Barr virusVascular ischemia:Primary ischemia is induced by cold or emotional stressSecondary ischemia caused by increased capillary permeability leading to exudation of fluid, edema and compression of microcirculationHereditary:Narrow fallopian canal due to hereditary predispositionAutoimmune DisordersClinical Features:Onset is suddenPatient is unable to close his eyes, on attempting to close the eye, eye ball turns up and out (Bell's phenomenon)Saliva dribbles from angle of mouthFace becomes asymmetricalTears flow down from the eye (epiphora)Pain in ear may precede or accompany the nerve paralysisSome complains of noise intolerance (stapedial paralysis) or loss of taste (involvement of chord tympani)Paralysis may be complete or incompleteBell's palsy is recurrent in 3-10% cases.Diagnosis:Diagnosis is by exclusion. All other known causes should be excluded.Nerve excitability tests are done daily or alternate days and compared with normal side to monitor nerve degeneration.Localizing the site of lesion (topodiagnosis) helps in establishing the etiology and also the site of surgical decompression of the nerve, if that becomes necessary. Treatment:General:ReassuranceRelief of pain by analgesicsCare of the eyePhysiotherapy or massage of the facial muscles gives psychological support to the patient Medical:Steroids:Prednisone is the drug of choice.If the patient presents within 1 week, the adult dose of prednisone is 1 mg/kg/day divided in morning and evening doses for 5 days.Patient is seen on 5th day, if paralysis is incomplete or recovering, dose is tapered over next 5 days.If paralysis is remains complete, the same dose is continued for another 10 days and thereafter tapered in next 5 days (total of 20 days).Surgical Treatment:Nerve decompression relieves pressure on the nerve fibers and improves the microcirculation of nerve. Vertical and tympanic segments of nerve are decompressed. Prognosis:Full recovery in 85-90% casesIncomplete recovery in 10-15% casesRecurrent facial palsy may not recover fullyPrognosis is good in incomplete Bell's palsy (95% complete recovery) and in those where recovery starts within 3 weeks of onset (75% complete recovery).
Category:
ENT
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