Current Concepts: Diagnosis and Management of Facial Paralysis

Electroneuronography,10 which we call neuromyography,11 is no more accurate than other electrical nerve tests. Because the purpose of treatment is to prevent degeneration, most practitioners agree that medical or surgical treatment should be instituted before the results of electrical tests become abnormal. The hyperacusis was not related to stapedial-muscle paralysis7 but probably represented a dysfunction of the cochlear division of the acoustic nerve.14 Herpes Zoster Herpes zoster facial paralysis is differentiated from Bell's palsy by increased severity of symptoms, the presence of vesicles, and a rising titer of antibody to varicella-zoster virus. [...]the most valuable tools for determining the prognosis in individual patients are careful observation of the progression (or lack of progression) of the paralysis and the use of electrodiagnostic tests to determine the rate and degree of nerve degeneration (commonly termed denervation). Other factors identified as associated with a severe course or a poor outcome (or both) were hyperacusis, decreased tearing, age above 60 years, associated diabetes, hypertension, psychoneuroses, and the presence of aural, anterior facial, or radicular pain.2, 15 Medical Treatment Discussing the diagnosis and prognosis should reassure most patients. Because the disease is viral and occurs in an otherwise healthy person in a characteristic fashion, no special studies need be performed.