Bell's
palsy recovered more completely and more rapidly with hyperbaric oxygen therapy
than with prednisone.
Clinical Bottom Line:
1.
Complete recovery was obtained with hyperbaric oxygen therapy in 95% of cases,
significantly better than the rate with prednisone treatment.
2.
Time to recovery was significantly shorter with HBO.
3. The
degree of deficit in those not fully recovered was less with hyperbaric.
Appraised
by: Mike Bennett, Dept. of Diving and
Hyperbaric Medicine, Prince of Wales Hospital
Sydney; Wednesday, 18 November, 1998
Clinical
Scenario: A patient with facial palsy of unknown
origin.
Three-part
Question: In patients with facial palsy of
unknown origin, does the application of hyperbaric oxygenation as compared to
the administration of steroids, result in earlier or more complete resolution of
the palsy?
Search
Terms: hyperbaric oxygenation, Bell's palsy
The
Study:
Single (?double)-blinded concealed
randomised controlled trial with intention-to-treat. Adult patients with
established diagnosis of moderate or severe Bell's palsy with less than 1 week
of facial weakness.
Control group (N = 37; 37 analysed): 8
days Prednisone (total 450mg) in a tailing dose plus sham hyperbaric exposure on
schedule below.
Experimental group (N = 42; 42
analysed): Placebo dosing regime as above plus hyperbaric oxygen therapy at
2.8ATA for 60 minutes, twice daily for five days.
The
Evidence:
|
Outcome |
Time
to Outcome |
Prednisone |
Hyperbaric |
Relative
risk reduction |
Absolute
risk reduction |
Number
needed to treat |
|
Complete
resolution |
9
months |
0.757 |
0.952 |
26% |
0.195 |
5 |
|
95%
CI |
|
|
|
6%
to 46% |
0.04
to 0.35 |
3
to 24 |
|
Nerve
excitability test improved |
9
months |
0 |
0.071 |
INF |
0.071 |
14 |
|
95%
CI |
|
|
|
|
0.15
to -0.01 |
7
to INF |
|
Complete
recovery and mild palsy |
9
months |
0.865 |
1.0 |
16% |
0.14 |
7 |
|
95%
CI |
|
|
|
3%
to 28% |
0.25
to 0.03 |
4
to 40 |
Time to outcome
Prednisone
Hyperbaric
P-value
Average
time
to
recovery
9 months
34.4 days
22 days
<0.001
Comments:
1 information lacking on randomisation
method and observer blinding.
2. Good placebo/sham was employed.
3. Clinical importance of the nerve
excitability test is unclear.
Expiry
date: November
2004
References:
1. Racic G,
Denoble PJ, Sprem N, Bojic L, Bota B. Hyperbaric oxygen as a therapy of Bell's
palsy. Undersea and Hyperbaric Medicine 1997; 24:35-38.
