• Users Online: 49
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 2  |  Page : 220-224

Effect of demographic factors, anthropometric factors, and comorbid diseases on recovery in the Bell's palsy subjects – A correlation study


Assistant Professor, SPB Physiotherapy College, Surat, Gujarat, India

Date of Submission14-Dec-2021
Date of Decision16-Jul-2022
Date of Acceptance20-Jul-2022
Date of Web Publication06-Dec-2022

Correspondence Address:
Sonali Desai
No. 902 Gopal Terrace, Near Jamnanagar BRTS, Canal Road, Bhatar Surat, Gujarat
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_131_21

Rights and Permissions
  Abstract 


OBJECTIVES: Bell's palsy is a condition of unilateral facial paralysis with the recovery rate varying from person to person. Various factors influence the prognosis of Bell's palsy subjects. Hence, the aim of this research was to examine the relationship between recovery of Bell's palsy and demographic, anthropometric, and the presence of comorbid diseases.
METHODOlOGY: A correlation study was conducted on a total of 70 (both male and female) subjects. Independent outcome measures were age, gender, side, height, weight, body mass index, presence of diabetes, hypertension, and dyslipidemia. Dependent outcome measure was Sunnybrook Facial Grading System which grades the recovery following Bell's palsy. Outcome measures were taken at baseline, after 20 days, and after 1 month.
RESULTS: Statistical analysis indicates that age, weight, diabetes, hypertension, and dyslipidemia have a significant correlation with recovery in Bell's palsy patients.
CONCLUSION: The positive correlation between weight and recovery indicated that low weight leads to delayed recovery. A negative correlation of recovery with age, diabetes, hypertension, and dyslipidemia indicates that increased age leads to delayed or incomplete recovery and the presence of comorbid diseases leads to delayed/incomplete recovery.

Keywords: Anthropometric factors, Bell's palsy, comorbid diseases, demographic factors


How to cite this article:
Desai S, Limbasiya R. Effect of demographic factors, anthropometric factors, and comorbid diseases on recovery in the Bell's palsy subjects – A correlation study. BLDE Univ J Health Sci 2022;7:220-4

How to cite this URL:
Desai S, Limbasiya R. Effect of demographic factors, anthropometric factors, and comorbid diseases on recovery in the Bell's palsy subjects – A correlation study. BLDE Univ J Health Sci [serial online] 2022 [cited 2023 Jan 28];7:220-4. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/2/220/362833



Bell's palsy is defined as unilateral weakness or paralysis of the face due to acute peripheral facial nerve dysfunction with no readily identifiable cause and with some recovery of function within 6 months.[1] It accounts for 49%–51% of all cases of facial weakness and for 75% of acute facial nerve paralysis.[2],[3] The annual incidence is 15–30/100,000 or about 1 out of 60 persons in a lifetime.[4] It has peak incidence usually between the ages of 15 and 50 years.[4],[5],[6],[7],[8]

Even though having many possible causes, exact etiology is still unknown.[8] The onset of Bell's palsy is sudden and usually evolves rapidly during a period of 1–7 days,[9],[10],[11] but it may also progress more slowly, reaching maximum weakness up to 1–3 weeks after onset.[1],[12],[13] Compression of the facial nerve at the internal auditory meatus leads to temporary or permanent loss of sensory or motor functions.[14]

Overall Bell's palsy has a very good prognosis, but about 15%–30% might have different degrees of squeal.[8],[15] Overall 80% of patients recover within a month or two.[16],[17] In some cases, full recovery takes up to 9 months[18] and incomplete recovery after Bell's palsy may have a long-term impact on quality of life.[4]

Various studies worldwide have established the effect of various clinical and electrophysiological factors on the degree of severity and duration of recovery such as electromyography findings, nerve conduction velocity findings, demographic factors, severity of initial palsy, severity 1 month after onset, postauricular pain, hearing changes, taste changes, change in tear production, previous ipsilateral palsy, hypertension, diabetes, obesity, smoking, alcohol consumption, and stapedius reflex.[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28] Some of these studies showed a significant correlation between specific factors and recovery rates. However, none of the studies compares the effect of various factors on the rate of recovery.

Even though Bell's palsy has been proven to have fair prognosis, the rate of recovery varies from patient to patient. Various studies have demonstrated the effect of various factors on recovery in Bell's palsy subjects. However, none of the studies shows a comparison between the effects of various factors on recovery in Bell's palsy. Hence, the purpose of this study is to compare the effect of demographic factors, anthropometric factors, and presence of comorbid diseases on recovery in Bell's palsy subjects.


  Methodology Top


Study design

This was an exploratory study.

Study population

Bell's palsy subjects were enrolled in the study.

Sampling

Convenient sampling was used.

Sample size

The sample size was 70 (calculated on the basis of prevalence rate, i.e. 1 in every 60 individuals).

Study area

This study was conducted in Surat, Gujarat, India.

Source of data

Data were collected from various hospitals, private physiotherapy clinics, and college outpatient departments in different areas of Surat city.

Inclusion criteria

  1. Subjects those who are willing to participate
  2. Bell's palsy patients (≤1 year)
  3. Both male and female genders
  4. Age: 18–75 years.[23],[29],[30],[31].


Exclusion criteria

  1. All patients with nonidiopathic origin, i.e., herpes zoster, Lyme disease, Ramsay Hunt syndrome, evidence of other traumatic, vascular, oncologic, otologic, or infectious etiologies ruled out by aural, neurologic, or clinical examination[32],[33]
  2. Recurrent Bell's palsy
  3. Unwillingness to participate
  4. Bilateral facial nerve palsy
  5. Other diseases of the central or peripheral nervous system.[34]


Procedure

All patients signed written consent before included in the study. Sunnybrook Facial Grading System was used as an independent outcome measure. Demographic factors, anthropometric factors, and comorbid diseases were used as dependent outcome measures. Dependent factors were taken only at baseline, whereas independent factor, i.e., Sunnybrook Facial Grading System, was taken at baseline (within 10 days), at 20 days, and after 3 months.

Sunnybrook Facial Grading System

The score of Sunnybrook Scale (SBS)[4] ranges from 0 to 100, where 0 is complete paralysis and 100 is normal facial function. The three sections in the SBS are (1) resting posture, (2) voluntary movement, and (3) synkinesis. All three sections are scored individually, and then, the scores are combined for a total or composite score. The formula for SBS score is “SBS = SBS movement − SBS rest − SBS synkinesis.” A higher total score relates to lower impairment while a lower total score relates to greater impairment. All the patients were evaluated by SBS at baseline (within 10 days), at 20 days, and after 1 month of onset.

Demographic factors

  • Age
  • Gender
  • Side of involvement.


Anthropometric factors

  • Weight
  • Height
  • Body mass index (BMI).


Diagnosis of diabetes, hypertension, and dyslipidemia

Diabetes, hypertension, and dyslipidemia were defined according to the guidelines from the National Heart, Lung, and Blood Institute and the American Heart Association.[35]

  1. Diabetes


    • Fasting blood glucose level ≥100 mg/dl
    • Using insulin or oral hypoglycemic agents.


  2. Hypertension:


    • Elevated blood pressure → ≥130 mmHg/≥85 mmHg
    • Current use of antihypertensive drugs.


  3. Dyslipidemia:


    • Hypertriglyceridemia (triglycerides ≥150 mg/dl)
    • Use of cholesterol-lowering medications; low high-density lipoprotein (HDL) cholesterol (HDL cholesterol <40 mg/dl for men and < 50 mg/dl for women).


Data analysis

The SPSS 26.0 software was used for data analysis. Standard statistical method was used for the calculation of means and standard deviation. The relationship between test variables (Sunnybrook Facial Grading Scale and other 16 factors affecting the recovery of Bell's palsy) was determined using multiple bivariate correlation, represented by the Pearson correlation coefficient. The level of statistical significance was set at P < 0.10


  Results Top


A total of 70 patients including 37 males and 33 females with a mean age of 43.25 were included in the study. Thirty seven patients had the right side of involvement, whereas 33 patients had the left side of involvement. Five subjects had one comorbid disease, 13 subjects had two comorbid diseases, and 29 subjects had three comorbid diseases, whereas 23 subjects did not have any comorbid diseases. A total of 32 subjects had normal BMI, whereas 1 was underweight, 31 were overweight, and 6 were Class I obese [Table 1].
Table 1: Demographic, anthropometric, and clinical variables among Bell's palsy subjects

Click here to view


Correlation between Sunnybrook Facial Grading Scale and all independent factors was done by Spearman's correlation coefficient. Correlation analysis shows a significant correlation of Sunnybrook Facial Grading Scale with age, weight, and all three comorbid conditions at onset, after 20 days, and after 3 months after onset. There was a positive significant correlation found between weight and SBS at all three levels, whereas a negative significant correlation was found between age, hypertension, diabetes, dyslipidemia, and SBS onset, SBS 20 days, and SBS 3 months [Table 2].
Table 2: Correlation analysis between demographic factors, anthropometric factors, comorbid diseases, and recovery rate in Bell's palsy

Click here to view



  Discussion Top


The purpose of the study was to investigate the relationship between various demographic, anthropometric, and comorbid diseases with recovery rates in Bell's palsy subjects. In this study, function recovery in Bell's palsy subjects was assessed using Sunnybrook Functional Grading System at baseline, after 20 days, and after 3 months. At the end of the study, a significant correlation of functional recovery grades with various demographic factors, anthropometric factors, and comorbid diseases among Bell's palsy subjects.

Among the demographic details, age was the only factor which had a negative significant correlation with functional recovery at onset, after 20 days, and at 3 months. A negative significant correlation indicates that the SBS score reduces with increased age. The recovery rate reduces with increased age. This might be due to the effects of aging on regeneration process. Monini et al. and Peitersen et al. support this finding. They stated that the possibility of recovery decreases significantly over the age of 45 and only about 1/3 of the patients over the age of 60 recover with normal functions.[18],[36] Prim et al. suggested that advanced age at the time of diagnosis was found as a poor prognostic factor.[37] In contrast to this, Lee et al. and Flifel et al. suggested no difference in recovery rates between age groups.[25],[38] However, other studies have found that age does not significantly affect the recovery of Bell's palsy. As per the study of Takemoto et al., Mantsopoulos et al., and Çetin et al., there is a little correlation between age and recovery.[13],[39],[40]

Our study shows a strong negative correlation between comorbid diseases such as diabetes, hypertension, and dyslipidemia with recovery rates of Bell's palsy. It means that the presence of comorbid diseases leads to lower scores on Sunny Broom Facial Grading System (SBFGS) which indicates poor recovery. These findings are supported by previous studies. Peitersen et al. found diabetes as a poor prognostic factor due to diabetic polyneuropathy.[17] Hongbo Zhang et al. concluded that among comorbid diseases, diabetes is the most important risk factor,[41] with reference to this finding that diabetes mellitus caused axonotmesis rather than neuropraxia depending on microangiopathy and low immunity, which in turn reduced recovery rates in Bell's palsy. Kanazawa et al. reported no significant differences between HB grades of diabetic and nondiabetic patient groups at baseline, but in support of our study, they found significantly lower recovery rates at the 6th month in diabetic subjects.[42] In contrast to this, Fujiwara et al. reported a lack of correlation between diabetes mellitus and Bell's palsy recovery.[43]

In the present study, hypertension and dyslipidemia are negatively correlated with recovery in Bell's palsy subjects. This finding is supported by Abraham et al. who have found the presence of hypertension as a poor prognostic indicator for patients with Bell's palsy.[44] The exact pathophysiologic mechanisms of the relationship between hypertension and Bell's palsy are controversial. Fluid retention, edema of the vasa nervorum, and increased susceptibility to viral infection due to higher cortisol levels might be the possible cause of elevated risk of Bell's palsy in hypertension patients, as in pregnancy. In contrast to this, Kanazawa et al. found no relation between hypertension and hypercholesterolemia with poor prognosis in Bell's palsy.[42] Çetin et al. concluded that two or more comorbid conditions affect the prognosis negatively and it is related with incomplete recovery.[40] Kudoh et al. found poor recovery in both diabetic and hypertensive subjects.[45] In addition to this, no correlation was found between recovery rates and diabetes, hypertension, or dyslipidemia in the study by Mohammad et al. Hypertension and recovery rates in Bell's palsy correlation are a controversial topic as hypertension and controlled medication might influence recovery.[24]


  Conclusion Top


The main purpose of this study was to find out the relation between recovery with Sunnybrook Facial Grading Scale and various demographic factors, anthropometric factors, and comorbid diseases. There was a highly negative correlation of age and all three comorbid conditions with the recovery rate in Bell's palsy. Weight had a positive correlation with recovery. Apart from this, no correlation was found between gender, side, BMI, and height with recovery rates.

Limitation

The subject size was limited to participants. Hence, the finding from this study cannot be largely generalized to other areas and countries. Hence, future research can be done with an increase in the subject's size. Other factors must be studied to find out their correlation with recovery in Bell's palsy subjects.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
May M, Hughes GB. Facial nerve disorders: Update 1987. Am J Otol 1987;8:167-80.  Back to cited text no. 1
    
2.
May M, Klein SR. Differential diagnosis of facial nerve palsy. Otolaryngol Clin North Am 1991;24:613-45.  Back to cited text no. 2
    
3.
Sun DQ, Andresen NS, Gantz BJ. Surgical management of acute facial palsy. Otolaryngol Clin North Am 2018;51:1077-92.  Back to cited text no. 3
    
4.
Holland J, Bernstein J. Bell palsy. Am Fam Physician 2011;84:947-8.  Back to cited text no. 4
    
5.
De Diego-Sastre JI, Prim-Espada MP, Fernández-García F. The epidemiology of Bell's palsy. Rev Neurol 2005;41:287-90.  Back to cited text no. 5
    
6.
Holland NJ, Weiner GM. Recent developments in Bell's palsy. BMJ 2004;329:553-7.  Back to cited text no. 6
    
7.
Prescott CA. Idiopathic facial nerve palsy (the effect of treatment with steroids). J Laryngol Otol 1988;102:403-7.  Back to cited text no. 7
    
8.
Grogan PM, Gronseth GS. Practice parameter: Steroids, acyclovir, and surgery for Bell's palsy (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:830-6.  Back to cited text no. 8
    
9.
Chow LC, Tam RC, Li MF. Use of electroneurography as a prognostic indicator of Bell's palsy in Chinese patients. Otol Neurotol 2002;23:598-601.  Back to cited text no. 9
    
10.
Melvin TA, Limb CJ. Overview of facial paralysis: Current concepts. Facial Plast Surg 2008;24:155-63.  Back to cited text no. 10
    
11.
Tiemstra JD, Khatkhate N. Bell's palsy: Diagnosis and management. Am Fam Physician 2007;76:997-1002.  Back to cited text no. 11
    
12.
Adour KK, Hilsinger RL Jr., Callan EJ. Facial paralysis and Bell's palsy: A protocol for differential diagnosis. Am J Otol 1985;Suppl: 68-73.  Back to cited text no. 12
    
13.
Takemoto N, Horii A, Sakata Y, Inohara H. Prognostic factors of peripheral facial palsy: Multivariate analysis followed by receiver operating characteristic and Kaplan-Meier analyses. Otol Neurotol 2011;32:1031-6.  Back to cited text no. 13
    
14.
Zandian A, Osiro S, Hudson R, Ali IM, Matusz P, Tubbs SR, et al. The neurologist's dilemma: A comprehensive clinical review of Bell's palsy, with emphasis on current management trends. Med Sci Monit 2014;20:83-90.  Back to cited text no. 14
    
15.
Peitersen E. Bell's palsy: The spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;549:4-30.  Back to cited text no. 15
    
16.
Goroll AH, Mulley AG. Primary Care Medicine: Office Evaluation and Management of the Adult Patient. 6th ed. Philadelphia (PA): Lippincott Williams & Williams; 2009.  Back to cited text no. 16
    
17.
Peitersen E. The natural history of Bell's palsy. Am J Otol 1982;4:107-11.  Back to cited text no. 17
    
18.
Wolfson AB. Narwood-Nuss Clinical Practice of Emergency Medicine. 5th ed. Philadelphia (PA): Lippincott Williams & Williams; 2009.  Back to cited text no. 18
    
19.
Volk GF, Klingner C, Finkensieper M, Witte OW, Guntinas-Lichius O. Prognostication of recovery time after acute peripheral facial palsy: A prospective cohort study. BMJ Open 2013;3:e003007.  Back to cited text no. 19
    
20.
Kasse CA, Cruz OL, Leonhardt FD, Testa JR, Ferri RG, Viertler EY. The value of prognostic clinical data in Bell's palsy. Braz J Otorhinolaryngol 2005;71:454-8.  Back to cited text no. 20
    
21.
Ikeda M, Nakazato H, Hiroshige K, Abiko Y, Sugiura M. 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. Otol Neurotol 2003;24:334-8.  Back to cited text no. 21
    
22.
Berg T, Axelsson S, Engström M, Stjernquist-Desatnik A, Pitkäranta A, Kanerva M, et al. The course of pain in Bell's palsy: Treatment with prednisolone and valacyclovir. Otol Neurotol 2009;30:842-6.  Back to cited text no. 22
    
23.
Gavilán C, Gavilán J, Rashad M, Gavilán M. Discriminant analysis in predicting prognosis of Bell's palsy. Acta Otolaryngol 1988;106:276-80.  Back to cited text no. 23
    
24.
Flifel ME, Belal T, Abou Elmaaty AA. Bell's palsy: Clinical and neurophysiologic predictors of recovery. Egypt J Neurol Psychiatry Neurosurg 2020;56:1-5.  Back to cited text no. 24
    
25.
Akcan FA, Dundar Y, Uluat A, Korkmaz H, Ozdek A. Clinical prognostic factors in patients with idiopathicperipheral facial nerve paralysis (Bell's palsy). Eur Res J 2017;3:170-4.  Back to cited text no. 25
    
26.
Kim SY, Oh DJ, Park B, Choi HG. Bell's palsy and obesity, alcohol consumption and smoking: A nested case-control study using a national health screening cohort. Sci Rep 2020;10:4248.  Back to cited text no. 26
    
27.
Matthews WB. Prognosis in Bell's palsy. Br Med J 1961;2:215-7.  Back to cited text no. 27
    
28.
Jabor MA, Gianoli G. Management of Bell's palsy. J La State Med Soc 1996;148:279-83.  Back to cited text no. 28
    
29.
Marsk E, Bylund N, Jonsson L, Hammarstedt L, Engström M, Hadziosmanovic N, et al. Prediction of nonrecovery in Bell's palsy using Sunnybrook grading. Laryngoscope 2012;122:901-6.  Back to cited text no. 29
    
30.
Berg T, Marsk E, Engström M, Hultcrantz M, Hadziosmanovic N, Jonsson L. The effect of study design and analysis methods on recovery rates in Bell's palsy. Laryngoscope 2009;119:2046-50.  Back to cited text no. 30
    
31.
Rowlands S, Hooper R, Hughes R, Burney P. The epidemiology and treatment of Bell's palsy in the UK. Eur J Neurol 2002;9:63-7.  Back to cited text no. 31
    
32.
Urban E, Volk GF, Geißler K, Thielker J, Dittberner A, Klingner C, et al. Prognostic factors for the outcome of Bells' palsy: A cohort register-based study. Clin Otolaryngol 2020;45:754-61.  Back to cited text no. 32
    
33.
Ushio M, Kondo K, Takeuchi N, Tojima H, Yamaguchi T, Kaga K. Prediction of the prognosis of Bell's palsy using multivariate analyses. Otol Neurotol 2008;29:69-72.  Back to cited text no. 33
    
34.
Mustafa AH, Suleiman AM. Bell's palsy: A prospective study. Int J Dent 2020;2020:2160256.  Back to cited text no. 34
    
35.
Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640-5.  Back to cited text no. 35
    
36.
Monini S, Lazzarino AI, Iacolucci C, Buffoni A, Barbara M. Epidemiology of Bell's palsy in an Italian Health District: Incidence and case-control study. Acta Otorhinolaryngol Ital 2010;30:198.  Back to cited text no. 36
    
37.
Prim MP, De Diego JI, Sanz O. Prognostic factors in patients with idiopathic facial paralysis (Bell's palsy): A prospective study. ORL J Otorhinolaryngol Relat Spec 1999;61:212-4.  Back to cited text no. 37
    
38.
Lee HY, Byun JY, Park MS, Yeo SG. Effect of aging on the prognosis of Bell's palsy. Otol Neurotol 2013;34:766-70.  Back to cited text no. 38
    
39.
Mantsopoulos K, Psillas G, Psychogios G, Brase C, Iro H, Constantinidis J. Predicting the long-term outcome after idiopathic facial nerve paralysis. Otol Neurotol 2011;32:848-51.  Back to cited text no. 39
    
40.
Çetin MA, Karakurt SE, İkincioğulları A, Ensari S, Dere H. The effects of age and comorbid diseases on Bell's palsy. B ENT 2018;15:179-83.  Back to cited text no. 40
    
41.
Zhang H, Du H, Qian M, Wang Y, Zhou S, Chen J, et al. A study of affecting the recovery of Chinese patients with Bell palsy. Medicine (Baltimore) 2019;98:e14244.  Back to cited text no. 41
    
42.
Kanazawa A, Haginomori S, Takamaki A, Nonaka R, Araki M, Takenaka H. Prognosis for Bell's palsy: A comparison of diabetic and nondiabetic patients. Acta Otolaryngol 2007;127:888-91.  Back to cited text no. 42
    
43.
Fujiwara T, Hato N, Gyo K, Yanagihara N. Prognostic factors of Bell's palsy: Prospective patient collected observational study. Eur Arch Otorhinolaryngol 2014;271:1891-5.  Back to cited text no. 43
    
44.
Abraham-Inpijn L, Oosting J, Hart AA. Bell's palsy: Factors affecting the prognosis in 200 patients with reference to hypertension and diabetes mellitus. Clin Otolaryngol Allied Sci 1987;12:349-55.  Back to cited text no. 44
    
45.
Kudoh A, Ebina M, Kudo H, Matsuki A. Delayed recovery of patients with Bell's palsy complicated by non-insulin-dependent diabetes mellitus and hypertension. Eur Arch Otorhinolaryngol 1998;255:166-7.  Back to cited text no. 45
    



 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Methodology
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed220    
    Printed6    
    Emailed0    
    PDF Downloaded26    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]