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Effects of Age on Delayed Facial Palsy After Otologic Surgery: A Systematic Review and Meta-Analysis
Benjamin D Lovin1, Alex D Sweeney1,2,3, Alyssa Claire Chapel4
1Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
Insights
Delayed facial palsy (DFP) after pediatric middle ear surgery is rare, occurring significantly less often than in adults. Children experience excellent recovery from DFP, supporting the viral reactivation hypothesis.
Area of Science:
- Otolaryngology
- Neurology
- Pediatric Surgery
Background:
- Delayed facial palsy (DFP) is a rare complication following middle ear (ME) surgery.
- Understanding the incidence, etiology, and prognosis of DFP in pediatric patients is crucial.
Purpose of the Study:
- To report 4 cases of DFP after pediatric ME surgery.
- To systematically review literature on DFP after pediatric otologic surgery.
- To evaluate the impact of age on DFP etiology, management, and prognosis.
Main Methods:
- Systematic review of PubMed, Cochrane Library, and Embase.
- Meta-analysis to assess age-related DFP incidence after cochlear implantation (CI).
- Multi-institutional retrospective review of pediatric DFP cases post-otologic surgery.
Main Results:
- DFP incidence after pediatric CI was 0.23% vs. 1.01% in adults (P < .001).
- Mean age of pediatric DFP cases was 6.9 years; onset averaged 5.4 days post-op.
- All pediatric patients achieved full facial recovery within an average of 23.5 days.
Conclusions:
- DFP after pediatric CI is rare and significantly less common than in adults.
- Excellent prognosis for pediatric DFP post-otologic surgery with rapid, full recovery.
- Viral reactivation hypothesis supported; steroid administration is a potential consideration.
Objectives:
To report 4 cases of delayed facial palsy (DFP) after pediatric middle ear (ME) surgery and systematically review and analyze the associated literature to evaluate the effects of age on DFP etiology, management, and prognosis.
Methods:
Systematic review of PubMed, Cochrane Library, and Embase for articles related to DFP after cochlear implantation (CI) was performed. These articles were assessed for level of evidence, methodological limitations, and number of cases. Meta-analysis was performed to assess the effects of age on DFP incidence. Furthermore, a comprehensive list of all pediatric DFP cases after otologic surgery was assembled through a multi-institutional retrospective review and systematic review of the literature.
Results:
Twenty-nine articles fit the criteria for inclusion in the meta-analysis. The incidence of DFP after CI was 0.23% and 1.01% for pediatric and adult cases, respectively. This difference was statistically significant (P < .001, odds ratio 4.36). Twenty-three cases, adding to the 4 presented herein, were suitable for a comprehensive list. The mean age was 6.9 years. Average postoperative day of paresis onset was 5.4, with an average maximum House-Brackmann grade of 3.5. All patients obtained full facial recovery after an average of 23.5 days.
Conclusions:
The systematic review demonstrates that DFP after pediatric CI is rare and occurs at a significantly lower rate than in adults, further supporting the viral reactivation hypothesis of DFP. The prognosis for pediatric DFP after otologic surgery is excellent, with a high rate of full recovery in a short time frame. However, steroid administration can be considered.
Level Of Evidence:
IIa.
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