Seung-Geun Yeo

Steroid-Antiviral Treatment Improves the Recovery Rate in Patients with Severe Bell’s Palsy

Objectives: The extent of facial nerve damage is expected to be more severe in higher grades of facial palsy, and the outcome after applying different treatment methods may reveal obvious differences between severe Bell’s palsy and mild to moderate palsy. This study aimed to systematically evaluate the effects of different treatment methods and related prognostic factors in severe to complete Bell’s palsy. Methods: This randomized, prospective study was performed in patients with severe to complete Bell’s palsy. Patients were assigned randomly to treatment with a steroid or a combination of a steroid and an antiviral agent. We collected data about recovery and other prognostic factors. Results: The steroid treatment group (S group) comprised 107 patients, and the combination treatment group (S+A group) comprised 99 patients. There were no significant intergroup differences in age, sex, accompanying disease, period from onset to treatment, or results of an electrophysiology test (P > 0.05). There was a significant difference in complete recovery between the 2 groups. The recovery (grades I and II) of the S group was 66.4% and that of the S+A group was 82.8% (P = 0.010). The S+A group showed a 2.6-times higher possibility of complete recovery than the S group, and patients with favorable electromyography showed a 2.2-times higher possibility of complete recovery. Conclusions: Combined treatment with a steroid and an antiviral agent is more effective in treating severe to complete Bell’s palsy than steroid treatment alone.

Clinical Analysis of 22 Cases of Automastoidectomy

Objective: Automastoidectomy is a destructive condition of the mastoid and middle ear cavity about which very little has been reported. 1) Know the clinical features and severities of automastoidectomy caused by chronic otitis media. 2) Evaluate the results of its surgical outcomes. Method: Retrospective study. Patients who visited outpatient clinic and were diagnosed with COM with automastoidectomy state by temporal bone CT from January 2003 to December 2011 were included in this study. All patients underwent surgery. Their postoperative states were evaluated at the outpatient clinic at least 6 months after surgery. Results: Two patients complained of facial palsy, 7 hearing disturbance, 10 otorrhea, and 3 otalgia. At physical examination, attic destruction and retracted tympanic membrane (TM) were observed in 12 patients, EAC destruction in 8, TM perforation in 4, and 1 had intact TM. All pathologic results were cholesteatoma. A total of 19 had canal wall down mastoidectomy, 2 had canal wall-up mastoidectomy, and 1 had subtotal petrosectomy. One had tympanoplasty type 1, 3 had columella over stapes head, 10 had interposition or columella over stapedial footplate and, 1 had tympanoplasty type 3. Overall hearing improvement rate was 9.0%. There was no recurrence. Conclusion: Automastoidectomy is a relatively rare condition of middle ear diseases. It could be caused by cholesteatomatous COM and non-cholesteatomatous COM. Hearing reconstructive procedures are generally not effective compared with other conditions. This study may be helpful to know the clinical features and surgical outcomes of this condition.