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

Abstract

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-weight dextran and pentoxifylline. For this regimen, the term antiphlogistic-rheologic infusion therapy (ARIT) has been coined.

Study design: Retrospective case-series review.

Setting: University-based hospital of otorhinolaryngology/head and neck surgery.

Patients: 334 patients suffering from sudden facial paralysis of unknown cause.

Intervention: Treatment consisted uniformly of prednisolone in a starting dosage of 250 mg tapering over 18 days and accompanying infusion of dextran and pentoxifylline.

Main outcome measures: Facial nerve function after 6 months, adverse effects of therapy and comorbidity.

Results: From 239 patients with nonrecurrent palsy having received treatment within 12 days after onset, 92% recovered completely (House-Brackmann [HB] Grade I) without sequelae. In incomplete palsy (HB Grade II-V), normal facial function was restored in 97% of cases. Results were significantly better in the group in which therapy had been started within 3 days after the onset of palsy. Other factors such as old age, hypertension, or diabetes did not seem to influence the functional outcome in this series. Serious adverse 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 superior to the most optimistic observations of the natural course.