K Plumbaum1,2, G F Volk1,2, D Boeger3, J Buentzel4, D Esser5, A Steinbrecher6, K Hoffmann7, P Jecker8, A Mueller9, G Radtke10, O W Witte11, O Guntinas-Lichius1,2. 1. Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany. 2. Facial Nerve Center Jena, Jena University Hospital, Jena, Germany. 3. Department of Otorhinolaryngology, Zentralklinikum, Suhl, Germany. 4. Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany. 5. Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany. 6. Department of Neurology, HELIOS-Klinikum, Erfurt, Germany. 7. Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar, Germany. 8. Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany. 9. Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany. 10. Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany. 11. Department of Neurology, Jena University Hospital, Jena, Germany.
Abstract
OBJECTIVES: To determine the inpatient management for patients with acute idiopathic facial palsy (IFP) in Thuringia, Germany. DESIGN: Population-based study. SETTING: All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012, in the German federal state, Thuringia. MAIN OUTCOME MEASURES: Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested. RESULTS: A total of 291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (odds ratio [OR=12.939; 95% confidence interval [CI]=3.599 to 46.516), gustatory testing (OR=6.878; CI=1.064 to 44.474) and audiometry (OR=32.505; CI=1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT (OR=0.192; CI=0.061 to 0.602), cerebrospinal fluid examination (OR=0.024; CI=0.006 to 0.102). A total of 131 patients (45%) showed a recovery to House-Brackmann grade≤II. A pathological stapedial reflex test (Hazard ratio [HR]=0.416; CI=0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500 mg (HR=0.579; CI 0.400 to 0.838) and no adjuvant physiotherapy (HR=0.568; CI=0.407 to 0.794) were treatment-related predictors of worse outcome. CONCLUSIONS: Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials.
OBJECTIVES: To determine the inpatient management for patients with acute idiopathic facial palsy (IFP) in Thuringia, Germany. DESIGN: Population-based study. SETTING: All inpatients with IFP in all hospitals with departments of otolaryngology and neurology in 2012, in the German federal state, Thuringia. MAIN OUTCOME MEASURES: Patients' characteristics and treatment were compared between departments, and the probability of recovery was tested. RESULTS: A total of 291 patients were mainly treated in departments of otolaryngology (55%) and neurology (36%). Corticosteroid treatment was the predominant therapy (84.5%). The probability to receive a facial nerve grading (odds ratio [OR=12.939; 95% confidence interval [CI]=3.599 to 46.516), gustatory testing (OR=6.878; CI=1.064 to 44.474) and audiometry (OR=32.505; CI=1.485 to 711.257) was significantly higher in otolaryngology departments, but lower for cranial CT (OR=0.192; CI=0.061 to 0.602), cerebrospinal fluid examination (OR=0.024; CI=0.006 to 0.102). A total of 131 patients (45%) showed a recovery to House-Brackmann grade≤II. A pathological stapedial reflex test (Hazard ratio [HR]=0.416; CI=0.180 to 0.959) was the only independent diagnostic predictor of worse outcome. Prednisolone dose >500 mg (HR=0.579; CI 0.400 to 0.838) and no adjuvant physiotherapy (HR=0.568; CI=0.407 to 0.794) were treatment-related predictors of worse outcome. CONCLUSIONS: Inpatient treatment of IFP seems to be highly variable in daily practice, partly depending on the treating discipline and despite the availability of evidence-based guidelines. The population-based recovery rate was worse than reported in clinical trials.
Authors: Josef Georg Heckmann; Peter Paul Urban; Susanne Pitz; Orlando Guntinas-Lichius; Ildikό Gágyor Journal: Dtsch Arztebl Int Date: 2019-10-11 Impact factor: 5.594
Authors: Orlando Guntinas-Lichius; Gerd Fabian Volk; Kerry D Olsen; Antti A Mäkitie; Carl E Silver; Mark E Zafereo; Alessandra Rinaldo; Gregory W Randolph; Ricard Simo; Ashok R Shaha; Vincent Vander Poorten; Alfio Ferlito Journal: Eur Arch Otorhinolaryngol Date: 2020-04-08 Impact factor: 2.503
Authors: Leonard Knoedler; Helena Baecher; Martin Kauke-Navarro; Lukas Prantl; Hans-Günther Machens; Philipp Scheuermann; Christoph Palm; Raphael Baumann; Andreas Kehrer; Adriana C Panayi; Samuel Knoedler Journal: J Clin Med Date: 2022-08-25 Impact factor: 4.964