Hidehisa Nakazato

Clinical factors that influence the prognosis of facial nerve paralysis and the magnitudes of influence.

Objective: To show the significance of various factors when predicting the outcome of facial nerve paralysis.

Facial nerve paralysis caused by middle ear cholesteatoma and effects of surgical intervention

Conclusions. The clinical and surgical findings of this study indicated advanced cholesteatoma in many patients with facial paralysis. The outcome of facial paralysis was good. Poor outcomes were observed in cases with petrosal cholesteatoma and in those who underwent surgery ≥2 months after the onset of paralysis. Objective. To investigate clinical features of cholesteatoma associated with facial paralysis. Material and methods. Sixteen patients with facial paralysis due to middle ear cholesteatoma were reviewed. After removal of the cholesteatoma lesion, a limited area of the fallopian canal, that in which facial nerve edema or redness was evident, was opened. Incision of the epineural sheath for nerve decompression was not performed. Results. Initial paralysis was incomplete in 11 patients (69%). The onset of paralysis was sudden in 12 patients (75%). Labyrinthine fistulae (n=9; 56%) and bone destruction in the cranial fossa (n=10; 63%) were frequently observed. Six patients (38%) were totally deaf due to labyrinthitis. The outcome of facial paralysis was good in 13 patients (81%). Patients who underwent surgery ≥2 months after the onset of paralysis frequently had a poor outcome. Paralysis was not improved in two cases with petrosal cholesteatoma.

To what extent do evaluations of facial paralysis by physicians coincide with self-evaluations by patients: Comparison of the Yanagihara method, the House-Brackmann method, and self-evaluation by patients

Objectives To understand to what extent evaluations of facial paralysis by physicians coincide with self-evaluations by patients. Study Design Prospective clinical study. Patients One hundred thirty-one patients (68 male patients and 63 female patients) with facial paralysis were included in the study. Interventions The relationship between the evaluation of facial paralysis using the Yanagihara system, the House-Brackmann grading system, and self-evaluation by patients was studied. Main Outcome Measures The paralysis scores and grade determined by physicians using the above two systems were well correlated with the self-evaluations by patients. Results The evaluation of subjective symptoms differed among individuals. Even patients who were evaluated as either completely paralyzed or cured according to the Yanagihara and House-Brackmann methods did not always rate their subjective symptoms as being consistent with these scores. Conclusion Evaluations with the two systems correlated significantly with self-evaluations by patients on the whole. These two methods of evaluation are considered appropriate not only for physicians but also for patients. In contrast, some discrepancies were observed. This point should be taken into account in routine patient care.

Anti-Borrelia burgdorferi antibodies in patients with facial paralysis

SummaryNinety-eight patients with facial paralysis were studied by an indirect enzyme-linked immunosorbent assay (ELISA) employing two types of Borrelia burgdorferi antigen, namely sonic extract and flagellum protein of B. burgdorferi. IgG or IgM antibodies were detected by sonic extract ELISA in 22 (32.4%) of 68 patients with Bells palsy, and in 2 (10.0%) of 20 patients with varicella-zoster virus infection. This difference was statistically significant (P<0.05). A positive reaction was more frequent with the sonic extract antigen, while the positive rates were significantly increaesd in Bells palsy patients with hyperglobulinemia (P<0.05). IgM antibodies were also significantly more frequently observed in patients who developed Bells palsy between October and March (P< 0.05). Since none of the patients had a history suggestive of Lyme disease, some kind of non-specific reaction and certain undefined factors linked to a positive reaction against B. burgdorferi could be involved in Bells palsy.

Anti-Borrelia burgdorferi Antibodies in Sera of Patients with Facial Paralysis

Borrelia burgdorferi is a pathogenic spirochete which causes Lyme disease mediated by members of the Ixodidae, as discovered in 1982 [1]. Lyme disease is a complex multisystem disorder. Many cases of this disease were found and reported for the first time in Lyme. Connecticut, United States in the latter half of the 1970s [2]. There are reports, particularly from Europe, maintaining that B. burgdorferi, which is the pathogenic spirochete of Lyme disease, is involved in causing Bell’s palsy [3–5]. Cases have also been described in Japan where ECM occurred after a tick bite and the patients were serologially diagnosed as having Lyme disease [6]. It is important therefore to examine the relation between Bell’s palsy and B. burgdorferi in Japan. In the present study, the authors focused on patients residing in or near Toky whose main complaints were associated with facial paralysis.