Conservative treatment of bell's palsy: —High dose steroid infusion with low-molecular dextran—

Abstract

The etiology of Bell's palsy has not been as yet completely elucidated and the treatment is empirical and controversial. The two most common forms of treatment are steroid therapy and surgery. On the basis of the pathophysiology of Bell's palsy that edema as well as primary or secondary ischemia lead to both compression and hypoxia, Stennert employed high doses of cortison for a strong antiphlogistic and antiedematous effect, and dextran in combination with pentoxifilline to increase peripheral nerve perfusion and reported high recovery rate. Since the past 3 years, we have been treating patients with Bell's palsy with a high dose of steroid plus low-molecular dextran (SD therapy). Hydrocortisone was added directly to 500ml of dextran solution with ATP and vitamins, starting with 500mg and finally down with 100mg during 7 days. Before we had adopted this regimen, the patients with Bell's palsy were treated with orally-administrated steroid. A half dose of steroid was administrated in the latter regimen. SD therapy was employed in 120 cases of Bell's palsy, and its results were compared with those of 82 cases with orally-administrated steroid. In a total of 67 cases with incomplete palsy, all cases obtained complete recovery within one month after the onset regardless of the mode of treatment. Each patients with complete palsy was examined with a nerve exitability test (NET) at the first visit and one week later. According to the response of NET, the patients with complete palsy were divided into the following three groups ; “good”, “poor” and “absent”. In “good” group, all cases with SD therapy had complete recovery, while the recovery rate of 31 cases with orally-administrated steroid therapy was 90%. This difference was statistically significant (p<0.05). In “poor” group, the recovery rates were 88% and 53% in SD group and oral administration group, respectively. This difference was statistically significant (p<0. 05). All cases in “absent” group remained incomplete recovery regardless of the mode of treatment. However, the final scores of facial movement were 82.1±12. 2 and 49. 2±8. 7 in SD group and oral administration group, respectively. This difference was statistically significant (p < 0. 05). These results indicate that SD therapy to the complete palsy surpass the orally-administrated steroid therapy, while all patients with incomplete palsy recover completely within one month after the onset regardless of the mode of treatment. The following conclusions were induced. In case of incomplete palsy, the orally-administrated steroid therapy is useful unless incomplete palsy progresses in complete palsy. In case of complete palsy, however, SD therapy should be started immediately. © 1989, The Oto-Rhino-Laryngological Society of Japan, Inc. All rights reserved.