Prognostic value of electromyography in acute peripheral facial nerve palsy

Objective: To analyze the value of electromyography in predicting recovery from acute idiopathic facial nerve paralysis. Study Design: Retrospective case-series review. Setting: University-based hospital department of otorhinolaryngology/head n eck surgery. Patients: Three hundred fifty-five patients with sudden facial paralysis of unknown cause (Bell's palsy). Intervention: Treatment consisted uniformly of high-dose prednisolone, dext ran, and pentoxifylline. Prognostication was based on electromyography perf ormed not earlier than 10 to 14 days after the onset of palsy. The findings were classified according to Seddon into neurapraxia and axonotmesis/ neur otmesis. There is an inherent statement on prognosis in this classification because neurapraxia is presumed to recover completely within 8 to 12 weeks , whereas axonotmesis is most likely to be followed by sequelae. Main Outcome Measures: Facial nerve function after 6 months. Results: Complete recovery was predicted correctly in 92.4% of cases. For t he relatively rare and therefore principally more difficult predictable eve nt defective recovery prognosis was still accurate in 80.8%. Conclusion: The detection of spontaneous fibrillation in needle electromyog raphy is a reliable sign predicting unfavorable outcome. An accuracy of 80. 8% for predicting unfavorable outcome may be sufficient to advise patients what to expect in the course of their facial nerve disorder. However, it se ems dubious to build a decision about surgical intervention on such a test, because in the process. unnecessary surgery would be accepted for as much as one fifth of the patient population.