|Year : 2012 | Volume
| Issue : 3 | Page : 140-142
Bell's palsy in early childhood: A series of six cases
Sunil Kumar, Sunil Garg, Aayush Mittal, Jatinder Kumar Sahni
Department of Otorhinolaryngology, Head and Neck Surgery, Lady Hardinge Medical College, New Delhi, India
|Date of Web Publication||12-Nov-2012|
Department of Otorhinolaryngology, Head and Neck Surgery, Lady Hardinge Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
Background and Objective: Bell's palsy is more uncommon in children than in adults and the diagnosis is always made by exclusion. Materials and Methods: In this retrospective study of 5 years, we diagnosed six children of Bell's palsy in age group between 4 months and 48 months. The parents were reassured and prognosis was explained in detail to them, and physiotherapy along with multivitamins as placebo was prescribed on outdoor basis. None of the children was prescribed with oral steroid. Results: All patients showed improvement with complete recovery in 67% cases over mean duration of 6.5 weeks, while partial recovery was noticed in the remaining 33% cases. Conclusion: In this retrospective study, we find that physiotherapy along with multivitamins as placebo without steroids is an effective alternative treatment for childhood Bell's palsy.
Keywords: Bell′s palsy, Children, Facial paralysis, Steroid
|How to cite this article:|
Kumar S, Garg S, Mittal A, Sahni JK. Bell's palsy in early childhood: A series of six cases. Indian J Otol 2012;18:140-2
| Introduction|| |
Bell's palsy in children is less common than adults, but they have a more favorable outcome as compared to adults.  It is not a life-threatening disorder, but it has significant functional and psychological effects on the child as well as the parents. It is an idiopathic facial nerve palsy whose diagnosis is always made by exclusion. In children, generally there is a serious underlying disorder behind facial palsy, therefore every differential diagnosis has to be carefully considered before labeling a case of Bell's palsy.  Treatment trials for this condition are few in children due to rarity of the problem.  There is no consensus regarding treatment in childhood Bell's palsy. We are presenting a retrospective study in a series of six cases of childhood Bell's palsy who were treated with physiotherapy and multivitamins only.
| Materials and Methods|| |
Six children ≤ 4 years of age were retrospectively reviewed who were diagnosed with Bell's palsy, during the period of 5 years from January 2007 to December 2011. Our institution has a pediatrics hospital with a separate pediatric ENT OPD. Cases presenting within 1 week of onset of facial palsy with grade IV and above according to House-Brackmann grading  were included in the study. Children with congenital facial palsy or diagnosed to have otitis media or history of trauma to face/head were excluded from the study.
Complete medical history of the patient was recorded which included age, sex, date of onset of palsy, sudden or gradual onset or whether it was first episode or relapse. Other associated symptoms like earache, ear discharge, and upper respiratory tract infections were also recorded. Apart from this, history of any trauma/surgery or history of any treatment taken for this condition before presentation to us was enquired. History of any other congenital disorder or any history of associated hearing impairment was taken.
A thorough clinical examination was done for any sinus, rashes, or mass/tumor over pinna or external auditory canal, and any other congenital anomaly was looked for. Apart from facial nerve, other cranial nerves were also examined. A complete systemic examination was also done. Computed tomography (CT) scan of the temporal region with brainstem was done in all the cases to rule out any congenital anomaly/intracranial mass lesion.
After making the diagnosis, parents were reassured and prognosis of the problem was completely explained to them. All the patients were given oral syrup multivitamins as placebo. Eye care was advised to every case by using lubricant eye drops 4 hourly and eye patching with ciprofloxacin ointment at night. Facial muscle exercises were demonstrated to the parents and they were advised to do these exercises 5-10 times for each muscle, 3 times a day for 14 days, and then the recovery was assessed. The patients were followed up every fortnightly for 3 months and monthly thereafter, and the results were recorded. The recovery of the nerve was assessed according to House-Brackmann scale.
| Results|| |
During the study period of 5 years, 133,733 patients visited the ENT outdoor, of whom 6 patients were diagnosed with Bell's palsy. The patients' age ranged from 4 to 46 months (mean age 21.3 months). Fifty percent (3) patients had complete paralysis [Figure 1] and the rest had incomplete paralysis [Figure 2] at the time of presentation. All the findings are summarized in [Table 1].
Sixty-seven percent of the patients recovered completely after treatment, with incomplete recovery in 33% of the patients. Patients who had their onset of recovery within 1 st month of onset of palsy recovered completely (mean duration 6.5 weeks) as compared to the patients who had onset of recovery after 1 month of onset of palsy. All the patients who had incomplete palsy at presentation got fully recovered. Both the patients who did not recover completely had complete palsy at the time of presentation.
| Discussion|| |
Bell's palsy is the most common cause of facial paralysis during childhood although it is much less common than in adults.  First and foremost concern for the parents of a childhood Bell's palsy is whether complete recovery can be expected. Therefore, prognosis needs to be explained in details and reassurance to be given, which form the important part of management of such cases.
The prognosis for Bell's palsy is said to be generally better in children than in adults. This difference in recovery rate is attributed to lower facial nerve to facial canal cross-sectional area ratio in children (0.31) than in adults (0.46).  Many factors affect the recovery of facial nerve in Bell's palsy. In cases of incomplete paralysis, the recovery rates are better than in patients with complete paralysis.  There have been many studies regarding recovery of Bell's palsy after steroid treatment, but mostly in adults. None of our patients were treated with steroids. Due to rarity of the problem in pediatric population, there are only few prospective studies, and that too are mostly non-randomized and non blinded. , Therefore, there is still no consensus regarding treatment in cases of childhood Bell's palsy.
We managed six cases of childhood Bell's palsy with physiotherapy and multivitamins as placebo without steroids. The mean duration of recovery in our patients was 6.5 weeks, which is comparable to that reported by Dhiravibulya (6.61 weeks). 
Unuvar  observed 100% recovery rates in both steroid and no treatment groups of childhood Bell's palsy. This equivocal result in steroid treatment vis-ΰ-vis no treatment in Bell's palsy in children further confuses the clinicians to treat such cases.
We summarize that Bell's palsy can be managed effectively by physiotherapy and multivitamins (placebo) alone without steroids, thus avoiding the potential side effects of the latter. As ours is a small series, further large series is required to substantiate our conclusion.
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[Figure 1], [Figure 2]