Corticosteroid treatment for idiopathic facial nerve paralysis: A meta-analysis

Objective: A meta-analysis was designed to evaluate facial recovery in pati ents with complete idiopathic facial nerve paralysis (IFNP) by comparing ou tcomes of those treated with corticosteroid therapy with outcomes of those treated with placebo or no treatment. Study Design: Meta-analysis of prospe ctive trials evaluating corticosteroid therapy for idiopathic facial nerve paralysis. Methods: A protocol was followed outlining methods for trial sel ection, data extraction, and statistical analysis. A MEDLINE search of the English language literature was performed to identify clinical trials evalu ating steroid treatment of IFNP, Three independent observers used an eight- point analysis to determine inclusion criteria. Data analysis was limited t o individuals with clinically complete IFNP. The endpoints measured were cl inically 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 m odel. Results: Forty-seven trials were identified. Of those, 27 were prospe ctive and 20 retrospective. Three prospective trials met the inclusion crit eria. Tests of heterogeneity indicate the trial with the smallest sample si ze (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 indica te corticosteroid treatment improves complete facial motor recovery for ind ividuals with complete IFNP, Rate difference demonstrates a 17% (99% CI, 0. 01-0.32) improvement in clinically complete recovery for the treatment grou p based on the random effects model. Conclusions: Corticosteroid treatment provides a clinically and statistically significant improvement in recovery of function in complete IFNP.