Systematic review of the prevalence of infectious serology in peripheral facial paralysis
Abstract Introduction and objectives. Peripheral facial paralysis is a condition of the facial nerve that often presents atrial septal pain, vital signs and facial paralysis. In the absence of published studies on the possible etiology of this paralysis, we proposed to carry out a systematic review to find out the serological prevalence of peripheral facial paralysis in the different studies published, including the one carried out at the university of Salamanca in the previous year. Materials and methods. Systematic review and meta-analysis of the studies published on the confirmation of peripheral facial paralysis by positive serology. Results. A total of 628 patients were analyzed, of which 76 had positive serology (12.10%). The meta-analysis shows heterogeneity among the results and publication bias. Conclusions. There is no evidence of a significant relationship between peripheral facial paralysis and recent positive serology, so there would be no benefit from antiviral treatment.
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1. De Diego-Sastre JI, Prim-Espada MP, Ferna?ndez-Garci?a F. The epidemiology of Bell’s palsy. Rev Neurol. 2005 Sep;41(5):287–90.
2. J. Sobotta. Atlas de anatomi?a humana. Cabeza, cuello y neuroanatomi?a. 23a Edicio?n. Paulsen F, Waschke J, editors. Barcelona: Elsevier Espan?a S.L.; 2012. 307–311 p.
3. Drake RL, Wayne Vogl A, Mitchell A. Gray. Anatomi?a para estudiantes. 2a Edicio?n. Barcelona: Elsevier Espan?a S.L.; 2010. 872 p.
4. Rouviere H, Dimas A. Anatomi?a Humana descriptiva, topogra?fica y funcional. Vol 1. 10a Edicio?n Barcelona: Editorial Masson S.A.; 1999. 249–253 p.
5. Garrido Calvo AM, Gonza?lez Espallargas E, Pino?s Laborda PJ, Gil Romea I. una para?lisis facial perife?rica. Med Integr. 2000;36(8):285–93.
6. Zhang W, Xu L, Luo T, Wu F, Zhao B, Li X. The etiology of Bell’s palsy: a review. J Neurol. 2019;0(0):10.
7. Garcia P. Para?lisis de Bell y serologi?a: ¿Estari?a indicado tratamiento antiviral? Trabajo de Fin de Grado. Facultad de Medicina. Universidad de Salamanca. 2019.
8. Sa?nchez-Meca J. Co?mo hacer una revisio?n sistema?tica y un meta-ana?lisis. Aula Abierta. 2010;38(2):53–64.
9. Aguayo-Albasini JL, Flores-Pastor B, Soria-Aledo V. Sistema GRADE: clasificacio?n de la calidad de la evidencia y graduacio?n de la fuerza de la recomendacio?n. Cir Esp. 2014;92(2):82– 8.
10. Pardal-refoyo JL, Pardal-pela?ez B. Anotaciones para estructurar una revisio?n sistema?tica. Rev. ORL. 2020;10(2):5p.
11. Love J, Dropmann D, Selker R. The jamovi proyect. 2020. jamovi. (Version 1.2) [Computer Software].
12. R Core Team. A language and enviroment for statistical computing. Vienna; 2019.(Version 3.6) [Computer Software].
13. Viechtbauer W. Conducting meta-analyses in R with the metafor. J Stat Softw. 2010;36(3):1– 48.
14. Genizi J, Golan-Shany O, Tarazov T, Pechter S, Assaf N, Segal I, et al. Does Herpes 6 Infection Have a Role in Bell’s Palsy Among Children and Adolescents? Pediatr Infect Dis J. 2019 Feb 1;Publish Ah:1.
15. Turriziani O, Falasca F, Maida P, Gaeta A, De Vito C, Mancini P, et al. Early collection of saliva specimens from Bell’s palsy patients: quantitative analysis of HHV-6, HSV-1, and VZV. J Med Virol. 2014 Oct;86(10):1752–8.
16. De Santos MAO, Caiaffa Filho HH, Vianna MF, Almeida AGDP, Lazarini PR. Varicella zoster virus in bell’s palsy: A prospective study. Braz J Otorhinolaryngol 2010;76(3):370–3.
17. Abiko Y, Ikeda M, Hondo R. Secretion and dynamics of herpes simplex virus in tears and saliva of patients with Bell’s palsy. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2002 Sep;23(5):779–83.
18. Pitka?ranta A, Piiparinen H, Mannonen L, Vesaluoma M, Vaheri A. Detection of human herpesvirus 6 and varicella-zoster virus in tear fluid of patients with Bell’s palsy by PCR. J Clin Microbiol. 2000 Jul;38(7):2753–5.
19. Lee HY, Kim MG, Park DC, Park MS, Byun JY, Yeo SG. Zoster sine herpete causing facial palsy. Am J Otolaryngol. 2012;33(5):565–71.
20. Stjernquist-Desatnik A, Skoog E, Aurelius E. Detection of herpes simplex and varicella-zoster viruses in patients with Bell’s palsy by the polymerase chain reaction technique. Ann Otol Rhinol Laryngol. 2006 Apr;115(4):306–11.
21. Linder T, Bossart W, Bodmer D. Bell’s palsy and Herpes simplex virus: fact or mystery? Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2005 Jan;26(1):109–13.
22. Gilbert SC. Bell’s palsy and herpesviruses. Herpes. 2002 Dec;9(3):70–3.
23. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med. 1996 Jan;124(1 Pt 1):27–30.
24. Lazarini PR, Vianna MF, Alcantara MPA, Scalia RA, Caiaffa Filho HH. Herpes simplex virus in the saliva of peripheral Bell’s palsy patients. Braz J Otorhinolaryngol. 2006;72(1):7–11.
25. Jamal GA, Al-Husaini A. Bell’s palsy and infection with rubella virus. J Neurol Neurosurg Psychiatry. 1983 Jul;46(7):678–80.
26. Tovi F, Sidi J, Haikin H, Sarov B, Sarov I. Viral infection and acute peripheral facial palsy. A study with herpes simplex and varicella zoster viruses. Isr J Med Sci. 1980 Aug;16(8):576– 80.
27. Hadar T, Sarov I. Specific IgG and IgA antibodies to herpes simplex virus (HSV)-induced surface antigen in patients with HSV infections and in healthy adults. J Med Virol. 1984;14(3):201–7.
28. Morgan M, Moffat M, Ritchie L, Collacott I, Brown T. Is Bell’s palsy a reactivation of varicella zoster virus? J Infect. 1995 Jan;30(1):29–36.
29. Said SM, Alyan ZA. Seroprevalence of herpes simplex and varicella zoster virus among diabetic and non-diabetic patients with acute peripheral facial palsy. Neurosciences (Riyadh). 2003 Jan;8(1):30–3.
30. Musani MA, Farooqui AN, Usman A, Atif S, Afaq S, Khambaty Y, et al. Association of herpes simplex virus infection and Bell’s palsy. J Pak Med Assoc. 2009 Dec;59(12):823–5.
31. Chakravarti A, Chaturvedi VN, Bhide V, Rodrigues JJ. Bell’s Palsy - herpes simplex virus type-1 a possible causative agent. Indian J Otolaryngol head neck Surg Off Publ Assoc Otolaryngol India. 1999 Apr;51(2):47–50.
32. Adour KK, Bell DN, Hilsinger RLJ. Herpes simplex virus in idiopathic facial paralysis (Bell palsy). JAMA. 1975 Aug;233(6):527–30.
33. Papaevangelou V, Falaina V, Syriopoulou V, Theodordou M. Bell’s palsy associated with Mycoplasma pneumoniae infection. Pediatr Infect Dis J. 1999 Nov;18(11):1024–6.
34. Trad S, Ghosn J, Dormont D, Stankoff B, Bricaire F, Caumes E. Nuclear bilateral Bell’s palsy and ageusia associated with Mycoplasma pneumoniae pulmonary infection. J Med Microbiol. 2005 Apr;54(Pt 4):417–9.
35. Pollack MA, Grose C, Friend H. Letter: Measles associated with Bell palsy. Am J Dis Child. 1975 Jun;129(6):747.
36. Furuta Y, Ohtani F, Chida E, Mesuda Y, Fukuda S, Inuyama Y. Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy. Auris Nasus Larynx. 2001 May;28 Suppl:S13-7.
37. Riga M, Kefalidis G, Chatzimoschou A, Tripsianis G, Kartali S, Gouveris H, et al. Increased seroprevalence of Toxoplasma gondii in a population of patients with Bell’s palsy: a sceptical interpretation of the results regarding the pathogenesis of facial nerve palsy. Eur Arch oto- rhino-laryngology Off J Eur Fed Oto-Rhino-Laryngological Soc Affil with Ger Soc Oto- Rhino-Laryngology - Head Neck Surg. 2011 Jul;268(7):1087–92.
38. Unlu Z, Aslan A, Ozbakkaloglu B, Tunger O, Surucuoglu S. Serologic examinations of hepatitis, cytomegalovirus, and rubella in patients with Bell’s palsy. Am J Phys Med Rehabil. 2003 Jan;82(1):28–32.
39. Imarhiagbe D, Prodinger WM, Schmutzhard E. Infective pathogens as a possible etiology of idiopathic peripheral facial paralysis. Wien Klin Wochenschr. 1993;105(21):611–3.
40. Chida K, Takase S. Serological diagnostic trial of the causative virus of Bell’s palsy by anti- herpes virus antibodies in the paired sera. Rinsho Shinkeigaku. 2000 Aug;40(8):791–6.
41. Vo?lter C, Helms J, Weissbrich B, Rieckmann P, Abele-Horn M. Frequent detection of Mycoplasma pneumoniae in Bell’s palsy. Eur Arch oto-rhino-laryngology Off J Eur Fed Oto- Rhino-Laryngological Soc Affil with Ger Soc Oto-Rhino-Laryngology - Head Neck Surg. 2004 Aug;261(7):400–4.
42. Jonsson L, Sundqvist VA, Thomander L. Anti-herpes IgG and IgG subclass antibodies in Bell’s palsy. Acta Otolaryngol. 1988;106(1–2):1–9.
43. Kaygusuz I, Go?dekmerdan A, Keles? E, Karlidag? T, Yalc?in S, Yildiz M, et al. The role of viruses in idiopathic peripheral facial palsy and cellular immune response. Am J Otolaryngol. 2004;25(6):401–6.
44. Mang WL, Bonkowsky VM. [Acute viral infections in association with idiopathic peripheral facial paralysis]. HNO. 1987 Jul;35(7):310–3.
45. Quant EC, Jeste SS, Muni RH, Cape A V., Bhussar MK, Peleg AY. The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: A meta-analysis. BMJ. 2009;339(7722):685.
46. Pallavicini V, Dane?s Carreras I. Eficacia de los glucocorticoides y los antivirales en el tratamiento de la para?lisis de Bell. Med Clin (Barc). 2011;136(11):501–3.
47. Youngs R, Fisher E. Antiviral treatment for Bell’s palsy? J Laryngol Otol. 2015;129(4):299.
48. Papan C, Kremp L, Weiß C, Petzold A, Schroten H, Tenenbaum T. Infectious causes of peripheral facial nerve palsy in children-a retrospective cohort study with long-term follow-up. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2019 Nov;38(11):2177–84.
49. Abdel-Aziz M, Azab NA, Khalifa B, Rashed M, Naguib N. The association of Varicella zoster virus reactivation with Bell’s palsy in children. Int J Pediatr Otorhinolaryngol. 2015 Mar;79(3):328–31.
50. Furuta Y, Ohtani F, Aizawa H, Fukuda S, Kawabata H, Bergstro?m T. Varicella-zoster virus reactivation is an important cause of acute peripheral facial paralysis in children. Pediatr Infect Dis J. 2005 Feb;24(2):97–101.
51. Kanerva M, Nissinen J, Moilanen K, Ma?ki M, Lahdenne P, Pitka?ranta A. Microbiologic findings in acute facial palsy in children. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc and Eur Acad Otol Neurotol. 2013 Sep;34(7):e82-7.
2. J. Sobotta. Atlas de anatomi?a humana. Cabeza, cuello y neuroanatomi?a. 23a Edicio?n. Paulsen F, Waschke J, editors. Barcelona: Elsevier Espan?a S.L.; 2012. 307–311 p.
3. Drake RL, Wayne Vogl A, Mitchell A. Gray. Anatomi?a para estudiantes. 2a Edicio?n. Barcelona: Elsevier Espan?a S.L.; 2010. 872 p.
4. Rouviere H, Dimas A. Anatomi?a Humana descriptiva, topogra?fica y funcional. Vol 1. 10a Edicio?n Barcelona: Editorial Masson S.A.; 1999. 249–253 p.
5. Garrido Calvo AM, Gonza?lez Espallargas E, Pino?s Laborda PJ, Gil Romea I. una para?lisis facial perife?rica. Med Integr. 2000;36(8):285–93.
6. Zhang W, Xu L, Luo T, Wu F, Zhao B, Li X. The etiology of Bell’s palsy: a review. J Neurol. 2019;0(0):10.
7. Garcia P. Para?lisis de Bell y serologi?a: ¿Estari?a indicado tratamiento antiviral? Trabajo de Fin de Grado. Facultad de Medicina. Universidad de Salamanca. 2019.
8. Sa?nchez-Meca J. Co?mo hacer una revisio?n sistema?tica y un meta-ana?lisis. Aula Abierta. 2010;38(2):53–64.
9. Aguayo-Albasini JL, Flores-Pastor B, Soria-Aledo V. Sistema GRADE: clasificacio?n de la calidad de la evidencia y graduacio?n de la fuerza de la recomendacio?n. Cir Esp. 2014;92(2):82– 8.
10. Pardal-refoyo JL, Pardal-pela?ez B. Anotaciones para estructurar una revisio?n sistema?tica. Rev. ORL. 2020;10(2):5p.
11. Love J, Dropmann D, Selker R. The jamovi proyect. 2020. jamovi. (Version 1.2) [Computer Software].
12. R Core Team. A language and enviroment for statistical computing. Vienna; 2019.(Version 3.6) [Computer Software].
13. Viechtbauer W. Conducting meta-analyses in R with the metafor. J Stat Softw. 2010;36(3):1– 48.
14. Genizi J, Golan-Shany O, Tarazov T, Pechter S, Assaf N, Segal I, et al. Does Herpes 6 Infection Have a Role in Bell’s Palsy Among Children and Adolescents? Pediatr Infect Dis J. 2019 Feb 1;Publish Ah:1.
15. Turriziani O, Falasca F, Maida P, Gaeta A, De Vito C, Mancini P, et al. Early collection of saliva specimens from Bell’s palsy patients: quantitative analysis of HHV-6, HSV-1, and VZV. J Med Virol. 2014 Oct;86(10):1752–8.
16. De Santos MAO, Caiaffa Filho HH, Vianna MF, Almeida AGDP, Lazarini PR. Varicella zoster virus in bell’s palsy: A prospective study. Braz J Otorhinolaryngol 2010;76(3):370–3.
17. Abiko Y, Ikeda M, Hondo R. Secretion and dynamics of herpes simplex virus in tears and saliva of patients with Bell’s palsy. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2002 Sep;23(5):779–83.
18. Pitka?ranta A, Piiparinen H, Mannonen L, Vesaluoma M, Vaheri A. Detection of human herpesvirus 6 and varicella-zoster virus in tear fluid of patients with Bell’s palsy by PCR. J Clin Microbiol. 2000 Jul;38(7):2753–5.
19. Lee HY, Kim MG, Park DC, Park MS, Byun JY, Yeo SG. Zoster sine herpete causing facial palsy. Am J Otolaryngol. 2012;33(5):565–71.
20. Stjernquist-Desatnik A, Skoog E, Aurelius E. Detection of herpes simplex and varicella-zoster viruses in patients with Bell’s palsy by the polymerase chain reaction technique. Ann Otol Rhinol Laryngol. 2006 Apr;115(4):306–11.
21. Linder T, Bossart W, Bodmer D. Bell’s palsy and Herpes simplex virus: fact or mystery? Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc [and] Eur Acad Otol Neurotol. 2005 Jan;26(1):109–13.
22. Gilbert SC. Bell’s palsy and herpesviruses. Herpes. 2002 Dec;9(3):70–3.
23. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N. Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med. 1996 Jan;124(1 Pt 1):27–30.
24. Lazarini PR, Vianna MF, Alcantara MPA, Scalia RA, Caiaffa Filho HH. Herpes simplex virus in the saliva of peripheral Bell’s palsy patients. Braz J Otorhinolaryngol. 2006;72(1):7–11.
25. Jamal GA, Al-Husaini A. Bell’s palsy and infection with rubella virus. J Neurol Neurosurg Psychiatry. 1983 Jul;46(7):678–80.
26. Tovi F, Sidi J, Haikin H, Sarov B, Sarov I. Viral infection and acute peripheral facial palsy. A study with herpes simplex and varicella zoster viruses. Isr J Med Sci. 1980 Aug;16(8):576– 80.
27. Hadar T, Sarov I. Specific IgG and IgA antibodies to herpes simplex virus (HSV)-induced surface antigen in patients with HSV infections and in healthy adults. J Med Virol. 1984;14(3):201–7.
28. Morgan M, Moffat M, Ritchie L, Collacott I, Brown T. Is Bell’s palsy a reactivation of varicella zoster virus? J Infect. 1995 Jan;30(1):29–36.
29. Said SM, Alyan ZA. Seroprevalence of herpes simplex and varicella zoster virus among diabetic and non-diabetic patients with acute peripheral facial palsy. Neurosciences (Riyadh). 2003 Jan;8(1):30–3.
30. Musani MA, Farooqui AN, Usman A, Atif S, Afaq S, Khambaty Y, et al. Association of herpes simplex virus infection and Bell’s palsy. J Pak Med Assoc. 2009 Dec;59(12):823–5.
31. Chakravarti A, Chaturvedi VN, Bhide V, Rodrigues JJ. Bell’s Palsy - herpes simplex virus type-1 a possible causative agent. Indian J Otolaryngol head neck Surg Off Publ Assoc Otolaryngol India. 1999 Apr;51(2):47–50.
32. Adour KK, Bell DN, Hilsinger RLJ. Herpes simplex virus in idiopathic facial paralysis (Bell palsy). JAMA. 1975 Aug;233(6):527–30.
33. Papaevangelou V, Falaina V, Syriopoulou V, Theodordou M. Bell’s palsy associated with Mycoplasma pneumoniae infection. Pediatr Infect Dis J. 1999 Nov;18(11):1024–6.
34. Trad S, Ghosn J, Dormont D, Stankoff B, Bricaire F, Caumes E. Nuclear bilateral Bell’s palsy and ageusia associated with Mycoplasma pneumoniae pulmonary infection. J Med Microbiol. 2005 Apr;54(Pt 4):417–9.
35. Pollack MA, Grose C, Friend H. Letter: Measles associated with Bell palsy. Am J Dis Child. 1975 Jun;129(6):747.
36. Furuta Y, Ohtani F, Chida E, Mesuda Y, Fukuda S, Inuyama Y. Herpes simplex virus type 1 reactivation and antiviral therapy in patients with acute peripheral facial palsy. Auris Nasus Larynx. 2001 May;28 Suppl:S13-7.
37. Riga M, Kefalidis G, Chatzimoschou A, Tripsianis G, Kartali S, Gouveris H, et al. Increased seroprevalence of Toxoplasma gondii in a population of patients with Bell’s palsy: a sceptical interpretation of the results regarding the pathogenesis of facial nerve palsy. Eur Arch oto- rhino-laryngology Off J Eur Fed Oto-Rhino-Laryngological Soc Affil with Ger Soc Oto- Rhino-Laryngology - Head Neck Surg. 2011 Jul;268(7):1087–92.
38. Unlu Z, Aslan A, Ozbakkaloglu B, Tunger O, Surucuoglu S. Serologic examinations of hepatitis, cytomegalovirus, and rubella in patients with Bell’s palsy. Am J Phys Med Rehabil. 2003 Jan;82(1):28–32.
39. Imarhiagbe D, Prodinger WM, Schmutzhard E. Infective pathogens as a possible etiology of idiopathic peripheral facial paralysis. Wien Klin Wochenschr. 1993;105(21):611–3.
40. Chida K, Takase S. Serological diagnostic trial of the causative virus of Bell’s palsy by anti- herpes virus antibodies in the paired sera. Rinsho Shinkeigaku. 2000 Aug;40(8):791–6.
41. Vo?lter C, Helms J, Weissbrich B, Rieckmann P, Abele-Horn M. Frequent detection of Mycoplasma pneumoniae in Bell’s palsy. Eur Arch oto-rhino-laryngology Off J Eur Fed Oto- Rhino-Laryngological Soc Affil with Ger Soc Oto-Rhino-Laryngology - Head Neck Surg. 2004 Aug;261(7):400–4.
42. Jonsson L, Sundqvist VA, Thomander L. Anti-herpes IgG and IgG subclass antibodies in Bell’s palsy. Acta Otolaryngol. 1988;106(1–2):1–9.
43. Kaygusuz I, Go?dekmerdan A, Keles? E, Karlidag? T, Yalc?in S, Yildiz M, et al. The role of viruses in idiopathic peripheral facial palsy and cellular immune response. Am J Otolaryngol. 2004;25(6):401–6.
44. Mang WL, Bonkowsky VM. [Acute viral infections in association with idiopathic peripheral facial paralysis]. HNO. 1987 Jul;35(7):310–3.
45. Quant EC, Jeste SS, Muni RH, Cape A V., Bhussar MK, Peleg AY. The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: A meta-analysis. BMJ. 2009;339(7722):685.
46. Pallavicini V, Dane?s Carreras I. Eficacia de los glucocorticoides y los antivirales en el tratamiento de la para?lisis de Bell. Med Clin (Barc). 2011;136(11):501–3.
47. Youngs R, Fisher E. Antiviral treatment for Bell’s palsy? J Laryngol Otol. 2015;129(4):299.
48. Papan C, Kremp L, Weiß C, Petzold A, Schroten H, Tenenbaum T. Infectious causes of peripheral facial nerve palsy in children-a retrospective cohort study with long-term follow-up. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2019 Nov;38(11):2177–84.
49. Abdel-Aziz M, Azab NA, Khalifa B, Rashed M, Naguib N. The association of Varicella zoster virus reactivation with Bell’s palsy in children. Int J Pediatr Otorhinolaryngol. 2015 Mar;79(3):328–31.
50. Furuta Y, Ohtani F, Aizawa H, Fukuda S, Kawabata H, Bergstro?m T. Varicella-zoster virus reactivation is an important cause of acute peripheral facial paralysis in children. Pediatr Infect Dis J. 2005 Feb;24(2):97–101.
51. Kanerva M, Nissinen J, Moilanen K, Ma?ki M, Lahdenne P, Pitka?ranta A. Microbiologic findings in acute facial palsy in children. Otol Neurotol Off Publ Am Otol Soc Am Neurotol Soc and Eur Acad Otol Neurotol. 2013 Sep;34(7):e82-7.
Corbacho-Zaldívar, M., & González-Sánchez, E. (2020). Systematic review of the prevalence of infectious serology in peripheral facial paralysis. Revista ORL, 12(2), 55–65. https://doi.org/10.14201/orl.23480
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