Hiroko Nishimura

Occurrence of Sequelae in Bell's Palsy

The occurrence of sequelae in 330 patients with Bells palsy followed up for more than 6 months was investigated. At least one of five kinds of sequelae (synkinesis, crocodile tears syndrome, spasm, contracture, tinnitus and/or hearing loss during facial movement) was observed in 30 of the 330 cases (9.1%). Sequelae occurred at 23.9-39.0 weeks (mean) after onset of palsy and at scores of 30-34 points (mean; full score 40 points). The incidence of sequelae was correlated to the degree of facial nerve dysfunction.

Tinnitus and/or hearing loss elicited by facial mimetic movement

Temporary tinnitus and/or hearing loss elicited by contraction of facial mimetic muscles are often observed on the affected side in patients recovering from facial nerve paralysis and in those with facial spasm. In order to clarify the mechanism of this phenomenon, changes in auditory threshold and middle ear compliance during voluntary contraction of mimetic muscles were investigated. The results suggest that this type of tinnitus and/or hearing loss is due to nonacoustic contraction of the stapedial muscle synchronous with contraction of mimetic muscles.

Treatment of hemifacial spasm with transcutaneous electrical stimulation

A transcutaneous electrical stimulation method was used to treat hemifacial spasms. This treatment was applied concomitantly with drug therapy to 21 patients, and was found effective in 17 patients (81%). Electrotherapy is considered to be useful in patients with mild spasms and in those with severe spasms for whom surgical treatment is not possible.

Statistical Observation of Facial Palsy

昭和52年1月から昭和57年9月までの6年9ヵ月間, 京大病院耳鼻咽喉科を訪れた顔神麻痺患者662名について統計的観察を行い以下の結果が得られた.(1) 顔神麻痺患者は, 外来新患数の1.8%を占めていた.(2) 年度別発生件数では, 各年ともベル麻痺が1番多く, 62.0～80.5%を占め, その他の頻度はまちまちであった.(3) 診断別分類では, ベル麻痺が1番多く, 447例 (67.5%), 以下, ハント症候群59例 (8.9%), 手術損傷性45例 (6.8%), 頭部外傷性45例 (6.8%), 先天性23例 (3.5%), 耳炎性15例 (2.3%), 中枢性6例 (0.9%), 側頭骨外疾患4例 (0.6%), 聴神経腫瘍2例 (0.3%), その他16例 (2.4%) であった.(4) ベル麻痺, ハント症候群における男女の差は著明でなかった.(5) ベル麻痺, ハント症候群とも左側にわずかに多かった.(6) ベル麻痺, ハント症候群の月別発生頻度は, 前者は11月に少なくなっている他は著明な差は見られなかった. 後者も季節的な一定の結論を出すのは困難であった.(7) ベル麻痺, ハント症候群とも青壮年が多く罹患していた.(8) 再発性麻痺は40例あり, 一側反復性麻痺14例, 両側交代性麻痺25例, 両側同時性麻痺1例を含んでいた.(9) ウイルス感染については, 検索を行った73例のうち, 感染ベルは21.3%で, ハント症候群では75%に帯状疱疹ウィルスに感染が認められた.

Reliability of Percutaneous Test for Facial Nerve Function

To evaluate the reliability of conventional tests for facial nerve denervation, comparisons of the thresholds and relationship with prognosis were made between the conventional percutaneous and direct stimulation methods in 11 cases of facial palsy decompressed and followed up for more than 6 months. Although all cases showed complete or severe nerve degeneration in the preoperative percutaneous stimulation test, the threshold for the direct intraoperative stimulation test varied from 4 V (normal) to more than 30 V. The results of the direct intraoperative stimulation test correlated well with prognosis (degree of improvement of palsy score). Our results indicate that the direct stimulation method is better than the percutaneous stimulation method as an electrodiagnostic test for nerve degeneration.

Reliability of percutaneous stimulation method for degeneration test of the facial nerve

To evaluate the reliability of conventional tests for facial nerve degeneration, comparison of the thresholds and correlation with prognosis were made between the conventional percutaneous and direct stimulation methods in 11 cases of facial palsy in which decompression operation were performed and follwed up for more than 6 months. Although all cases showed the findings of complete or high degree nerve degeneration with the preoperative percutaneous stimulation test, the threshold for the intraoperative direct stimulation test varied from 4 volts (normal) to more than 30 volts. The results of intraoperative direct stimulation test correlated well with prognosis (degree of improvement of palsy score). The cases with thresholds within 30 volts showed good recovery of palsy (more than 32 points of palsy score), while the cases with thresholds more than 30 volts showed plasy scores less than 28 points except one case. Our results indicates that the direct stimulation method is better than the percutaneous stimulation method as an electrodiagnostic test for nerve degeneration.