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A Systematic Review and Meta-analysis

John K. Goudakos, MD, MSc; Konstantinos D. Markou, MD, PhD

Arch Otolaryngol Head Neck Surg. 2009;135(6):558-564.

Objective  To review systematically and meta-analyze the results of all randomized controlled trials (RCTs) for the treatment of patients with Bell palsy with corticosteroids vs corticosteroids plus antiviral agents.

Data Sources  A MEDLINE, EMBASE, Cochrane Library, and CENTRAL database search, followed by extensive hand-searching for the identification of relevant studies. No time and language limitations were applied.

Study Selection  Prospective RCTs on the treatment of patients with Bell palsy.

Data Extraction  Odds ratios (ORs), 95% confidence intervals (CIs), and tests for heterogeneity were reported.

Data Synthesis  Five studies were eventually identified and systematically reviewed. Meta-analysis was performed for 4 studies. Regarding the complete recovery rate of facial nerve paralysis 3 months after initiation of therapy, the current systematic review and meta-analysis suggests that the addition of an antiviral agent does not provide any benefit (OR, 1.03 [95% CI, 0.74-1.42]; P = .88). The same conclusion emerged at posterior (fourth, sixth, and ninth) months of assessment. Subgroup analysis, conducted on the basis of time point of therapy initiation, type of antiviral agent, and blindness of assessments did not change the results obtained. The occurrence rate of adverse effects attributable to therapy choice was not significantly different between patients receiving corticosteroids and those following combined treatment.

Conclusion  The present systematic review and meta-analysis, based on the currently available evidence, suggests that the addition of an antiviral agent to corticosteroids for the treatment of Bell palsy is not associated with an increase in the complete recovery rate of the facial motor function.

Author Affiliations: First Department of Otorhinolaryngology–Head and Neck Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

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