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

Sonali Desai; Rajiv Limbasiya

doi:10.4103/bjhs.bjhs_131_21

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

Sonali Desai, Rajiv Limbasiya
Assistant Professor, SPB Physiotherapy College, Surat, Gujarat, India

Date of Submission	14-Dec-2021
Date of Decision	16-Jul-2022
Date of Acceptance	20-Jul-2022
Date of Web Publication	06-Dec-2022

Correspondence Address:
Sonali Desai
No. 902 Gopal Terrace, Near Jamnanagar BRTS, Canal Road, Bhatar Surat, Gujarat
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/bjhs.bjhs_131_21

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 Jun 3];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

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

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

Exclusion criteria

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]
Recurrent Bell's palsy
Unwillingness to participate
Bilateral facial nerve palsy
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]

Diabetes

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

Hypertension:

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

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

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

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 6^th 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

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.

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