Idiopathic facial nerve paralysis: a randomized double blind controlled study of placebo versus prednisone

Idiopathic facial nerve paralysis (IFNP) is a common malady. Because its etiology is unclear, there are a variety of treatment options. Studies to date have not clearly established the benefits of treatment with oral steroids (prednisone). The authors performed a randomized double-blind controlled study comparing the use of placebo versus prednisone which shows that prednisone-treated patients benefit from early treatment. Seventy-six patients met inclusion criteria and completed follow-up until recovery; 35 patients received prednisone and 41 received placebo. Their mean age was 36.8 years. Facial nerve function was assessed using the House-Brackmann facial nerve grading scale, as well as a variety of other measures. Patients were evaluated pretreatment, regularly post-treatment until judged recovered (return of facial function to a grade III or better), and at 6 months after recovery. Difference in mean time to resolution for the prednisone (51.4 days) and placebo (69.3 days) groups was not statistically significant. There was a significant difference in grade at recovery, with the placebo group having a higher proportion of grade III results (P < .03). Eight of 10 patients with electroneurography (ENOG) evidence of denervation were in the placebo group and accounted for 6 of the 7 grade III results. However, the difference in proportion of patients with evidence of denervation for the prednisone (5.7%) and placebo (19.5%) groups did not achieve statistical significance. This study shows that patients treated with prednisone have less denervation than placebo-treated patients. They also have a significant improvement in facial grade at recovery compared to placebo-treated patients. Therefore, the authors recommend that all patients at risk for developing denervation receive prednisone treatment.