HYPERBARIC OXYGEN THERAPY (HBOT)

AN “ADJUVANT” TO BELL’S PALSY TREATMENT

Abstract

The role of steroids in the treatment of Bell’s palsy is well known provided patients
present within 72hrs of symptoms onset. If patients present late or with severe Bell’s palsy
the effect of steroids or other treatment modalities is not yet clear. Aim of this study was to
evaluate the effect of HBOT along with oral steroids in treatment of such patients. Setting:
Diving department at Armed Forces Hospital King Abdul Aziz Naval Base Jubail, Kingdom of
Saudi Arabia (KSA). Period: January 2010 to Dec. 2015. Methods: Bell’s palsy patients of
age 13 years and above were treated with steroids & HBOT. Prednisolone 60mg was given
orally for one week to all patients & those patients who could tolerate HBOT were selected for
treatment with Hyperbaric Oxygen in a closed chamber at 2.5 ATA, 90 minutes a day and five
days a week. HBOT was continued till complete recovery or up to 20 sessions before declaring
partial recovery or failure. Assessment was done by physician using House-Brackmann
grading system for Facial nerve dysfunction. Patients were followed up to 3 months before
declaring partial recovery or treatment failure. Results: Treatment was started on 125 patients
but 15 patients could not tolerate HBOT due to ear pain (10 patients) or high blood pressure
(5 patients) in the HBOT chamber whereas 10 patients did not show up for follow up so only
100 patients completed the treatment. Out of 100, 22(22%) patients had mild (grade I to II), 40
patients (40%) had moderate (grade III to IV) and 38 patients (38%) had severe (grade V to VI)
Bell’s palsy. Majority of patients (85%) presented after 72hrs of symptoms onset. At 3 months
of follow up 90% (n=90) patients had full recovery whereas 10% (n=10) patients had partial
recovery. Severity of disease (OR 0.125, CI 0.025---0.6255, p =0.00595) and time between onset
of symptoms and start of treatment >2weeks (OR 0.0966 CI 0.0187---0.4987, p=0.00280) were
statistically significant. Conclusion: Combination of Hyperbaric Oxygen therapy and steroids is