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J Acupunct Res > Volume 31(1); 2014 > Article
Kim, Lee, Nam, and Kim: A Study of Psychological Distress, Anxiety and Depression on Motor Recovery of Acute Bell’s Palsy Patients’ Facial Muscle
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Objectives :

The aim of this study is to investigate the influence of anxiety and depression on motor recovery of acute Bell’s palsy to estimate how much psychological factors affect the clinical prognosis.

Methods :

A total of 20 inpatients with acute unilateral Bell’s palsy within 1 week of onset participated in this study. The severity of participants’ facial palsy was measured by Yanagihara(Y-system) score, FDI and House-Brackmann scale at the time of 1 week and 3 weeks from the onset. The motor recovery of acute Bell’s palsy is defined as ΔY-system during 2 weeks. Beck anxiety scale(BAI) and the center for epidermiologic studies depression scale(CES-D) were adopted to assess anxiety and depression, respectively. Correlation analysis and linear regression analysis were conducted between ΔY-system and prognostic factors including anxiety and depression.

Results :

Significant associations were found between ΔY-system and depression(CES-D) but no significant associations were found between ΔY-system and other prognostic factors, hypertension, diabetes, postauricular pain, disgeusia, age, degree of initial palsy and anxiety(BAI). And a regression equation with 0.295 for coefficient of determination was obtained. Through this analysis, the ΔY-system can be predicted using regression equation which cover 29.5 % of depression index(CES-D).

Conclusion :

Depression is a significant clinical prognostic factor on motor recovery of acute Bell’s palsy. So, Bell’s palsy treatment should be combined with psychological care and support.

Fig. 1.
Study flow chart
Table 1.
Yanagihara's Unweighed Grading System
Scale of five rating
At rest 0 1 2 3 4
Wrinkle forehead 0 1 2 3 4
Blink 0 1 2 3 4
Closure of eye lightly 0 1 2 3 4
Closure of eye tightly 0 1 2 3 4
Closure of eye on involved side only 0 1 2 3 4
Wrinkle nose 0 1 2 3 4
Whistle 0 1 2 3 4
Grin 0 1 2 3 4
Depress lower lip 0 1 2 3 4
Table 2.
Gross Grading System of House-Brackmann
Grade Description Characteristics
I Normal Normal facial function all areas
II Mild dysfunction Gross Slight weakness noticeable on close inspection may have very slight synkinesis
At rest Normal symmetry and tone
  Forehead : Moderate to good function
  Eye : complete closure with minimum effort
  Mouth : Slight asymmetry

III Moderate dysfunction Gross obvious but not disfiguring difference between two sides, noticeable but not severe synkinesis, contracture, and/or hemifacial spasm
At rest normal symmetry and tone
  Forehead : slight to moderate movement
  Eye : complete closure with effort
  Mouth : slightly weak with maximum effort

IV Moderately severe dysfunction Gross obvious weakness and/or disfiguring asymmetry
At rest normal symmetry and tone
  Forehead : none
  Eye : incomplete closure
  Mouth : asymmetric with maximum effort

V Severe dysfunction Gross : only barely perceptible
At rest : asymmetry
  Forehead : none
  Eye : incomplete closure
  Mouth : slight movement

VI Total paralysis No movement
Table 3.
Baseline Characteristics
Total n=20 n %
Sex Male 6 30
Female 14 70
Age(years) 45.45±11.95a (19∼65)b
Period of treatment(days) 15.25±2.57a (12∼20)b

Hypertension existence 4 20
nonexistence 16 80
Diabetes mellitus existence 4 20
nonexistence 16 80
Postauricular pain existence 10 50
nonexistence 10 50
disgeusia existence 6 20
nonexistence 14 80
Initial H-B Gr H-B Gr II 1 5
H-B Gr III 5 25
H-B Gr IV 8 40
H-B Gr V 6 30
Final H-B Gr H-B Gr II 10 50
H-B Gr III 5 25
H-B Gr IV 5 25
H-B Gr V 0 0

BAI* score 8.70±6.54a(0∼23)b
CES-D** score 13.95±7.98a(3∼34)b
ΔY-system 10.13±4.72a(3.0∼21.5)b
ΔFDI***-P 22.50±14.00a (0∼50)b
ΔFDI-S 15.80±15.33a(−4∼60)b

a mean±standard deviation.

b Min ∼ Max.

* beck anxiety inventory.

** the center for epidermiologic studies depression scale.

*** facial disability index − physical / social.

Table 4.
Comparison of ΔY-system* Score According to Existence of HTN, DM, Postauricular Pain, Disgeusia
Existence Nonexistence p**
HTN 8.75±4.50 10.47±4.85 0.617
DM 13.88±5.48 9.19±4.17 0.148

Postauricular pain 9.60±4.01 10.65±5.51 0.739

Disgeusia 11.5±4.10 9.56±4.99 0.207

* final Y mean - initial Y mean.

** p-value of Mann Whitney U test < 0.05.

Values are ΔY-system scores(means ± standard deviation).

Table 5.
Correlation between ΔY-system and Age, Initial Y Mean Score
Correlation coefficient*
Age 0.032
Initial Y mean −0.007

* correlation coefficient is Spearman’s correlation coefficient.

Table 6.
Correlation between Psychological Factors and Improvement of Bell’s Palsy
Correlation coefficient** p*
  ΔY-system −0.172 0.467
  ΔFDI-P 0.121 0.612
  ΔFDI-S 0.144 0.544

  ΔY-system −0.568 0.009*
  ΔFDI-P −0.031 0.898
  ΔFDI-S 0.094 0.694

* correlation is significant at the 0.05 level(2-tailed).

** correlation coefficient is Spearman’s correlation coefficient.

Table 7.
Summary of Simple Linear Regression Analysis
R R2 Unstandardized β p
0.543 0.295 −0.321 0.013*

Coefficients of determinant(R), squared R(R2) regression coefficient(β)

* regression equation is significant (p < 0.05)

VI. References

1. Min YK, Ahn CB, Jang KJ, et al. An Analysis of Clinical Prognosis Factors of Bell’s palsy. The J of Korean Acupuncture and Moxibustion Society. 2008;25(3):163–77.

2. Kim CY, Kim JI, Lee SH, Park DS, Koh HK. A Study of Correlation between Electromyography (EMG) and the Heart Rate Variability(HRV) Test, and Their Role as Predicting Factors for Peripheral Facial Palsy Prognosis. The J of Korean Acupuncture and Moxibustion Society. 2008;25(2):189–97.

3. Ikeda M, Abiko Y, Kukimoto N, Omori H, Nakazato H, Ikeda K. Clinical factors that influence the prognosis of facial nerve paralysis and the magnitudes of influence. Laryngoscope. 2005;115(5):855–60.
crossref pmid
4. Prim MP, De Diego JI, Sanz O. Prognostic factors in patients with idiopathic facial paralysis(Bell’s palsy): a prospective study. ORL J Otorhinolaryngol Relat Spec. 1999;61(4):212–4.
crossref pmid
5. Morishima Naohito, Yagi Ryo, Shimizu Kazuhiko, Ota Susumu. Prognostic factors of synkinesis after Bell’s palsy and Ramsay Hunt syndrome. Auris Nasus Larynx. 2013;40(5):431–4.
crossref pmid
6. Hwang JH, Lim DJ, Lee HJ, Cho HS, Kim KH, Kim SH. Clinical Comparison Studies on Bell’s Palsy Patients by Existence of Postauricural Pain. The J of Korean Acupuncture and Moxibustion Society. 2006;23(6):9–18.

7. Yang KR, Song HS. Influence of Dysgeusia on Prognosis of Peripheral Facial Paralysis. The J of Korean Acupuncture and Moxibustion Society. 2007;24(3):1–8.

8. Ahn CB, Yoon HM, Jang KJ, et al. An Analysis of Clinical Prognosis Factors of Peripheral Facial Palsy and the Effects of Electrodiagnostic Test. The J of Korean Acupuncture and Moxibustion Society. 2007;24(4):209–23.

9. Fu L, Bundy C, Sadiq SA. Psychological distress in people with disfigurement from facial palsy. Eye (Lond). 2011;25(10):1322–6.
crossref pmid pmc
10. Kuga M, Ikeda M, Kukimoto N, et al. An assessment of physical and psychological stress of patients with facial paralysis. Nihon Jibiinkoka Gakkai Kaiho (Japanese). 1998;101(11):1321–7.
11. Cross T, Sheard CE, Garrud P, et al. Impact of facial paralysis on patients with acoustic neuroma. Laryngoscope. 2000;110(9):1539–42.
crossref pmid
12. Yoo JH, Han WH, Lee DK. Neuropsychologic Analysis of Acute Bell’s Palsy. The Korean Society for Clinical Neurophysiology. 2009;11(2):48–53.

13. Huang B, Xu S, Xiong J, Huang G, Zhang M, Wang W. Psychological factors are closely associated with the Bell's palsy: a case-control study. J Huazhong Univ Sci Technol Med Sci. 2012;32(2):272–9.
crossref pmid
14. Islam S, Ahmed M, Walton GM, Dinan TG, Hoffman GR. The association between depression and anxiety disorders following facial trauma a comparative study. Injury. 2010;Jan;41(1):92–6.
crossref pmid
15. Van Swearingen JM, Cohn J, Turnbull J, Mirzai T, Johnson P. Psychological distress: linking impairment with disability in facial neuromotor disorders. Otolaryngol Head Neck Surg. 1998;118(6):790–6.
crossref pmid
16. Kwon HY, Cho TS, Son IS, et al. The Evaluation of Improvement of Bell’s palsy by Yanagihara’s System. The J of Korean Acupuncture and Moxibustion Society. 2002;19(1):118–26.

17. Yook SP, Kim ZS. A clinical study on the Korean version of Beck Anxiety Inventory: comparative study of patient and non-patient. Korean Journal of Clinical Psychology. 1997;16(1):185–97.

18. Radloff LS. The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurement. 1997;1(3):385–401.
19. Kim RB, Park KS, Lee JH, Kim BJ, Chun JH. Factors Related to Depression Symptom and the Influence of Depression Symptom on Self-rated Health Status, Outpatient Health Service Utilization and Quality of Life. Korean J of Health Education and Promotion. 2011;28(1):81–92.

20. Cho MJ, Kim KH. Diagnostic Validity of the CES-D(Korean Version) in the Assessment of DSM-III-R Major Depression. J of Korean Neuropsychiatric Association. 1993;32(3):381–99.

21. Kim JI, Seo JC, Lee SH, Choi DY, Kang SK, Koh HK. The clinical observation on Bell’s palsy according to facial nerve grading system. The J of Korean Acupuncture and Moxibustion Society. 2002;19(5):112–23.

22. Van Swearingen JM, Brach JS. The Facial Disability Index: reliability and validity of a disability assessment instrument for disorders of the facial neuromuscular system. Phys Ther. 1996;76(12):1288–98.
crossref pmid
23. National Teacher Training Center for Health Personnel. Family medicine. Seoul: Seoul National University Press. 2001:520–2.

24. Lee HY, Byun JY, Park MS, Yeo SG. Effect of aging on the prognosis of Bell's palsy. Otol Neurotol. 2013;Jun;34(4):766–70.
crossref pmid
25. Riga M, Kefalidis G, Danielides V. The role of diabetes mellitus in the clinical presentation and prognosis of Bell palsy. J Am Board Fam Med. 2012;Nov–Dec;25(6):819–26.
crossref pmid
26. Fujiwara T, Hato N, Gyo K, Yanagihara N. Prognostic factors of Bell's palsy: prospective patient collected observational study. Eur Arch Otorhinolaryngol. Published online(1 Sep 2013).
27. Mantsopoulos K, Psillas G, Psychogios G, Brase C, Iro H, Constantinidis J. Predicting the long-term outcome after idiopathic facial nerve paralysis. Otol Neurotol. 2011;Jul;32(5):848–51.
crossref pmid
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