Corticosteroid Treatment for Idiopathic Facial Nerve Paralysis: A Meta-analysis

• Published in: The Laryngoscope Vol. 110; no. 3; pp. 335 - 341
• Main Authors: Ramsey, Mitchell Jay, DerSimonian, Rebecca, Holtel, Michael R., Burgess, Lawrence P. A.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Hoboken, NJ John Wiley & Sons, Inc 01-03-2000; Wiley-Blackwell
• Subjects: Adrenal Cortex Hormones - therapeutic use; analysis; Anti-Inflammatory Agents - therapeutic use; Bell Palsy - drug therapy; Bell's palsy; Biological and medical sciences; Clinical Trials as Topic; Confidence Intervals; corticosteroids; Data Interpretation, Statistical; Ear, auditive nerve, cochleovestibular tract, facial nerve: diseases, semeiology; Ent. Stomatology; Facial Nerve - drug effects; Facial Paralysis - drug therapy; Glucocorticoids - therapeutic use; Humans; idiopathic facial nerve paralysis; Medical sciences; Meta; Non tumoral diseases; Otorhinolaryngology. Stomatology; Pharmacology. Drug treatments; Placebos; Prednisolone - therapeutic use; Prednisone - therapeutic use; Prospective Studies; Recovery of Function; Retrospective Studies; Sample Size; Treatment Outcome; Human; Corticosteroid; Nervous system diseases; Motor system disorder; Idiopathic; Facial paralysis; Facial nerve; Metaanalysis; Prospective; Chemotherapy; Cranial nerve disease; Treatment; ENT disease; Biological effect; Comparative study; Bibliographic review
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200003000-00001

Objective A meta‐analysis was designed to evaluate facial recovery in patients with complete idiopathic facial nerve paralysis (IFNP) by comparing outcomes of those treated with corticosteroid therapy with outcomes of those treated with placebo or no treatment.
Study Design Meta‐analysis of prospective trials evaluating corticosteroid therapy for idiopathic facial nerve paralysis.
Methods A protocol was followed outlining methods for trial selection, data extraction, and statistical analysis. A MEDLINE search of the English language literature was performed to identify clinical trials evaluating steroid treatment of IFNP. Three independent observers used an eight‐point analysis to determine inclusion criteria. Data analysis was limited to individuals with clinically complete IFNP. The endpoints measured were clinically complete or incomplete facial motor recovery. Effect magnitude and significance were evaluated by calculating the rate difference and Fisher's Exact Test P value. Pooled analysis was performed with a random effects model.
Results Forty‐seven trials were identified. Of those, 27 were prospective and 20 retrospective. Three prospective trials met the inclusion criteria. Tests of heterogeneity indicate the trial with the smallest sample size (RD = −0.19; 95% CI, −0.58–0.20), to be an outlier. It was excluded from the final analysis. Analyses of data from the remaining two studies indicate corticosteroid treatment improves complete facial motor recovery for individuals with complete IFNP. Rate difference demonstrates a 17% (99% CI, 0.01–0.32) improvement in clinically complete recovery for the treatment group based on the random effects model.
Conclusions Corticosteroid treatment provides a clinically and statistically significant improvement in recovery of function in complete IFNP.