Abstract
Objective: To study the relationship between various electrodiagnostic modalities in acute facial palsy. Setting: Academic tertiary care center. Patients: One-hundred and six patients who presented with traumatic or non-traumatic acute facial paralysis (House-Brackmann, HB, grade 6/6) between 2008 and 2017 and underwent acute electrodiagnostic testing. Intervention: Electroneurography (ENoG) using nasolabial fold (NLF) or nasalis muscle (NM) methods, and volitional electromyography (EMG) in all patients. Main outcome measures: Percent degeneration of ipsilateral facial nerve compound muscle action potentials (CMAP) on NLF- and NM-ENoG, presence or absence of muscle unit potentials (MUPs) on EMG. Results: Extent of facial nerve degeneration measured by NLF- and NM-ENoG were highly correlated (r = 0.85, P <.01) on each test and on serial testing. NLF- and NM-ENoG concordantly diagnosed ≥90% degeneration in 44 patients (80%), of whom 32 patients were diagnosed to have 100% degeneration by both methodologies. Absence of MUPs on EMG was 63% sensitive and 92% specific for ≥90% degeneration on ENoG, with a positive predictive value of 90%. For patients with Bell's palsy, percent degeneration on ENoG was also correlated to HB score at 1 year. Surgical decompression resulted in mean HB scores of 2.2 and 3.0 for patients with Bell's palsy and trauma, respectively. Conclusions: NM-ENoG may be a valid and comparable method to NLF-ENoG for predicting the recovery of facial nerve function in acute paralysis. Absence of MUPs on EMG is a specific measure of severe degeneration and highly predictive of candidacy for surgical decompression. Level of evidence: Level 3.
Original language | English (US) |
---|---|
Pages (from-to) | 928-935 |
Number of pages | 8 |
Journal | Laryngoscope investigative otolaryngology |
Volume | 5 |
Issue number | 5 |
DOIs | |
State | Published - Oct 1 2020 |
Externally published | Yes |
Keywords
- Bell's palsy
- electrodiagnostic testing
- electroneurography
- facial nerve decompression
- facial paralysis
- herpes zoster
- temporal bone fracture
ASJC Scopus subject areas
- Surgery
- Otorhinolaryngology