IDIOPATHIC FACIAL-NERVE PARALYSIS - A RANDOMIZED DOUBLE-BLIND CONTROLLED-STUDY OF PLACEBO VERSUS PREDNISONE

Idiopathic facial nerve paralysis (IFNP) is a common malady. Because i ts etiology is unclear, there are a variety of treatment options. Stud ies to date have not clearly established the benefits of treatment wit h oral steroids (prednisone). The authors performed a randomized doubl e-blind controlled study comparing the use of placebo versus prednison e which shows that prednisone-treated patients benefit from early trea tment. Seventy-six patients met inclusion criteria and completed follo w-up until recovery; 35 patients received prednisone and 41 received p lacebo. Their mean age was 36.8 years. Facial nerve function was asses sed using the House-Brackmann facial nerve grading scale, as well as a variety of other measures. Patients were evaluated pretreatment, regu larly post-treatment until judged recovered (return of facial function to a grade III or better), and at 6 months after recovery. Difference in mean time to resolution for the prednisone (51.4 days) and placebo (69.3 days) groups was not statistically significant. There was a sig nificant difference in grade at recovery, with the placebo group havin g a higher proportion of grade III results (P<.03). Eight of 10 patien ts with electroneurography (ENOG) evidence of denervation were in the placebo group and accounted for 6 of the 7 grade III results. However, the difference in proportion of patients with evidence of denervation for the prednisone (5.7%) and placebo (19.5%) groups did not achieve statistical significance. This study shows that patients treated with prednisone have less denervation than placebo-treated patients. They a lso have a significant improvement in facial grade at recovery compare d to placebo-treated patients. Therefore, the authors recommend that a ll patients at risk for developing denervation receive prednisone trea tment.