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Steroid use in L yme disease‐associated facial palsy is associated with worse long‐term outcomes
Author(s) -
Jowett Nate,
Gaudin Robert A.,
Banks Caroline A.,
Hadlock Tessa A.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26273
Subject(s) - medicine , synkinesis , palsy , post hoc analysis , retrospective cohort study , facial paralysis , bell palsy , confidence interval , pediatrics , bell's palsy , surgery , alternative medicine , pathology
Objective The purpose of this study was to determine whether differences in long‐term facial function outcomes following acute Lyme disease‐associated facial palsy (LDFP) exist between patients who received antibiotic monotherapy (MT); dual therapy (DT) with antibiotics and corticosteroids; and triple therapy (TT) with antibiotics, corticosteroids, and antivirals. Study Design Retrospective cohort. Methods All patients with a prior diagnosis of unilateral LDFP who presented to our center between 2002 and 2015 were retrospectively assessed for inclusion. Two blinded experts graded static, dynamic, and synkinesis parameters of facial functions using standardized video documentation of facial function. Results Fifty‐one patients were included. The mean time of assessment following LDFP onset was 15.1 months (range 0.3–84 months). Significantly worse facial outcomes were seen among those who received DT and TT as compared to those who received MT, most pronounced among those assessed 12 months or later following onset of LDFP (Dynamic— P = 0.031, post hoc MT vs. TT: mean difference [MD], 15.83; 95% confidence interval [CI], 1.54–30.13; P = 0.030. Synkinesis— P = 0.026, post hoc MT vs. DT: MD, 21.50; 95% CI, 0.68–42.32; P = 0.043, post hoc MT vs. TT: MD, 19.22; 95% CI, 2.23–36.22; P = 0.027). Conclusion An association between corticosteroid use in acute LDFP and worse long‐term facial function outcomes has been demonstrated. Care should be taken in differentiating viral or idiopathic facial palsy (e.g., Bell palsy) from LDFP. Level of Evidence 4. Laryngoscope , 127:1451–1458, 2017