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Acute peripheral facial palsy occurs annually in 30 in 1,000,000 individuals in the general population. Bell’s palsy and Ramsay Hunt syndrome account for about 70% of cases of peripheral facial palsy. They are believed to be caused by viral reactivation leading to inflammation and entrapment neuropathy in the narrow fallopian canal. Due to their anti-inflammatory effect, systemic corticosteroid is widely used as treatment. The authors undertook a systematic review and meta-analysis to investigate the efficacy and safety of intratympanic steroid therapy (ITST) in patients with Bell’s palsy and Ramsay Hunt syndrome. The primary endpoint was non-recovery of the facial palsy at the end of the follow-up period. Secondary outcomes were any adverse effect. Suitable studies included were three randomised controlled trials and two cohort studies. In total, 350 individuals were enrolled for meta-analysis. Comparison was made between individuals with combined ITST-systemic corticosteroid therapy and systemic corticosteroid only therapy. The authors found that combined ITST-systemic corticosteroid therapy was associated with a relative reduction in non-recovery facial function of about 60% of patients with Bell’s palsy and Ramsay Hunt syndrome. Subgroup analysis suggested that shorter duration between ITST (such as daily injections) improved chances of recovery. Only one patient had tympanic membrane perforation. The authors acknowledged that the studies eligible were of low quality due to the study design, variable follow-up of 13.5 to 52 weeks, and lack of electroneurography. Moreover, ITST’s action, which is on the tympanic segment of the facial nerve, does not account for the narrowest labyrinthine portion, often enhanced in Bell’s palsy and Ramsay Hunt syndrome on MRI. In conclusion, I feel that it is difficult to recommend ITST routinely for Bell’s palsy and Ramsay Hunt syndrome. Further well-designed studies are required to investigate this further.

Intratympanic corticosteroid for Bell’s palsy and Ramsay Hunt syndrome: Systematic review and meta-analysis.
Fujiwara T, Iwata S, Hosokawa Y, Mitani S.
2021; Article in Press.
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Praneta Kulloo

London Deanery, UK.

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