Annals of Rehabilitation Medicine

Electrodiagnosis

Prognostic Value of Electroneuronography in Severe Cases of Facial Palsy: Minwoo Woo, Doyoung Yuk, Seo Won Choi, Jongmin Lee, Hyun Haeng Lee; Ann Rehabil Med 2023;47(6):511-518. Published online November 22, 2023; DOI: https://doi.org/10.5535/arm.23082

Objective
To examine the prognostic value of electroneuronography (ENoG) in predicting functional recovery in severe cases of acute facial palsy.
Methods
Patients with severe degrees of facial palsy (initial House–Brackmann [HB] grades IV to VI) with available electrodiagnostic studies conducted 2–4 weeks after symptom onset were reviewed retrospectively. The patients were categorized into “good recovery” and “poor recovery” groups, with the former showing mild to no dysfunction (HB I to III) and the latter exhibiting moderate to severe dysfunction (HB IV to VI) on follow-up evaluation, 2 months after onset. ENoG amplitudes in four facial muscles (frontalis, nasalis, orbicularis oculi, and orbicularis oris), as well as age, sex, affected side, disease etiology, comorbidities, and laboratory findings, were compared between the two groups.
Results
Thirty-seven patients were included. Twenty-nine of the patients showed “good recovery,” and eight showed “poor recovery” at 2 months after symptom onset. Univariate analysis yielded no significant difference in age, sex, affected side, disease etiology, comorbidities, and laboratory findings between the two groups. Preserved ENoG amplitudes (individual, average, and trimmed means) were significantly higher in the good recovery group than in the poor recovery group (p<0.005). Sex (p=0.038) and the ENoG of the nasalis muscle, acquired 2–4 weeks from symptom onset (p=0.004), showed significant differences in multivariate regression analysis.
Conclusion
This study suggests that the female sex and lower ENoG of the nasalis muscle, acquired 2–4 weeks from symptom onset, have negative prognostic value for the 2-month functional outcome of severe facial palsy cases.

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Rare Occurrence of Internal Auditory Canal Stenosis Accompanied With Congenital Facial Palsy in a 3-Month-Old Infant: A Case Report: Se-Heum Park, Woo-Jin Kim, Yun-Jung Lim, Cheol-Won On, Ji-Ho Park, Eun-Ho Min; Ann Rehabil Med 2020;44(3):256-259. Published online June 30, 2020; DOI: https://doi.org/10.5535/arm.19148

Abstract
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Internal auditory canal (IAC) stenosis with hypoplasia of the facial and vestibulocochlear nerves is a rare cause of congenital facial palsy. In this case report, a 3-month-old female infant was referred for a neurological developmental assessment for developmental delay and congenital facial palsy. Upon evaluation of developmental delay, hearing loss was detected. Following a magnetic resonance imaging scan of the brain and a computed tomography scan of the temporal bone, IAC stenosis with hypoplasia of facial and vestibular nerves was diagnosed. This is a rare case of IAC stenosis in an infant with initial presentations of left facial palsy and developmental delay associated with hearing loss in the left ear. We strongly suggest that IAC stenosis be considered a cause of congenital facial palsy in infants, especially in patients with developmental delay. In infants with congenital facial palsy, a thorough physical examination and neurological developmental assessment should be performed.

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G Selvarajan, R Vaishnavi, P Mithun Anand, Balaji Jeevanandham
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G. Selvarajan, R. Vaishnavi, Mithun Anand Prateep, Balaji Jeevanandham
Indian Journal of Otology.2022; 28(1): 84. CrossRef

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Churg-Strauss Syndrome Presented With Hearing Impairment and Facial Palsy: Jeong-Hyun Byun, Jong-Hoo Lee, In-Sung Choi; Ann Rehabil Med 2014;38(6):852-855. Published online December 24, 2014; DOI: https://doi.org/10.5535/arm.2014.38.6.852

Abstract
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Churg-Strauss syndrome (CSS) is a rare systemic necrotizing vasculitis. Cranial nerve involvement is very rare in CSS. A 59-year-old woman had complained of both hearing impairments for eight months and left facial palsy for three months. Left facial and cochlear neuropathies were detected in electrodiagnostic studies. Paranasal sinus computed tomography (CT) showed chronic pansinusitis. Chest CT revealed eosinophilic infiltration in the right upper lobe. Tissue biopsy of the right inferior turbinate displayed necrotizing vasculitis with eosinophilic infiltration. She was diagnosed as CSS, based on the presence of eosinophilia, pulmonary infiltration, paranasal sinusitis, and biopsy containing blood vessels with extravascular eosinophils. She was treated with intravenous and oral steroids and azathioprine, showing relatively good prognosis on facial palsy and hearing impairment. We report a very rare case of CSS presented with hearing impairment and facial palsy.

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Dysphagia in Ramsay Hunt's Syndrome - A Case Report -: Jae Hoon Shim, Jin-Woo Park, Bum Sun Kwon, Ki Hyung Ryu, Ho Jun Lee, Woo Hyun Lim, Jung Hwan Lee, Young Geun Park; Ann Rehabil Med 2011;35(5):738-741. Published online October 31, 2011; DOI: https://doi.org/10.5535/arm.2011.35.5.738

Abstract
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Ramsay-Hunt syndrome is caused by varicella zoster virus infection in the geniculate ganglion of the facial nerve. It is characterized by facial palsy, otic pain, and herpetic vesicles around the auricle and external auditory canal. Additionally, symptoms may develop related to other cranial nerve involvement, such as dizziness or hearing loss by the vestibulocochlear nerve being invaded. We report a rare case of a Ramsay-Hunt syndrome patient who developed dysphagia due to multiple cranial nerve involvement including the glossopharyngeal nerve and vagus nerve.

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