Bell's palsy: A 10-year experience with antiphlogistic-rheologic infusion therapy

Objective: Treatment of idiopathic peripheral facial paralysis has remained controversial in many aspects. The authors report their experience with a protocol based on high-dose prednisolone with intravenous low-molecular-wei ght dextran and pentoxifylline. For this regimen, the term antiphlogistic-r heologic infusion therapy? (ARIT) has been coined. Study Design: Retrospective case-series review. Setting: University-based hospital of otorhinolaryngology/head and neck sur gery. Patients: 334 patients suffering from sudden facial paralysis of unknown ca use. Intervention: Treatment consisted uniformly of prednisolone in a starting d osage of 250 mg tapering over 18 days and accompanying infusion of dextran and pentoxifylline. Main Outcome Measures: Facial nerve function after 6 months, adverse effect s of therapy and comorbidity. Results: From 239 patients with nonrecurrent palsy having received treatmen t within 12 days after onset, 92% recovered completely (Honse-Brackmann [HB ] Grade I) without sequelae. In incomplete palsy (HB Grade II-V), normal fa cial function was restored in 97% of cases. Results were significantly bett er in the group in which therapy had been stat ted within 3 days after the onset of palsy. Other factors such as old age, hypertension, or diabetes di d not seem to influence the functional outcome in this series. Serious adve rse effects requiring termination of therapy were observed in 1.2% of cases . Conclusion: ARIT for Bell's palsy is safe and leads to recovery rates super ior to the most optimistic observations of the natural course.