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Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods

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 a...

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Autores principales: Andresen, Nicholas S., Zhu, Vivian, Lee, Andrew, Sebetka, Wendy, Kimura, Jun, Hansen, Marlan R., Gantz, Bruce J., Sun, Daniel Q.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585247/
https://www.ncbi.nlm.nih.gov/pubmed/33134541
http://dx.doi.org/10.1002/lio2.458
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author Andresen, Nicholas S.
Zhu, Vivian
Lee, Andrew
Sebetka, Wendy
Kimura, Jun
Hansen, Marlan R.
Gantz, Bruce J.
Sun, Daniel Q.
author_facet Andresen, Nicholas S.
Zhu, Vivian
Lee, Andrew
Sebetka, Wendy
Kimura, Jun
Hansen, Marlan R.
Gantz, Bruce J.
Sun, Daniel Q.
author_sort Andresen, Nicholas S.
collection PubMed
description 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.
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spelling pubmed-75852472020-10-30 Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods Andresen, Nicholas S. Zhu, Vivian Lee, Andrew Sebetka, Wendy Kimura, Jun Hansen, Marlan R. Gantz, Bruce J. Sun, Daniel Q. Laryngoscope Investig Otolaryngol Otology, Neurotology, and Neuroscience 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. John Wiley & Sons, Inc. 2020-09-10 /pmc/articles/PMC7585247/ /pubmed/33134541 http://dx.doi.org/10.1002/lio2.458 Text en © 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Otology, Neurotology, and Neuroscience
Andresen, Nicholas S.
Zhu, Vivian
Lee, Andrew
Sebetka, Wendy
Kimura, Jun
Hansen, Marlan R.
Gantz, Bruce J.
Sun, Daniel Q.
Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods
title Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods
title_full Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods
title_fullStr Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods
title_full_unstemmed Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods
title_short Electrodiagnostic testing in acute facial palsy: Outcomes and comparison of methods
title_sort electrodiagnostic testing in acute facial palsy: outcomes and comparison of methods
topic Otology, Neurotology, and Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7585247/
https://www.ncbi.nlm.nih.gov/pubmed/33134541
http://dx.doi.org/10.1002/lio2.458
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