Bell's Palsy is unilateral (one-sided) facial
paralysis of sudden onset. The cause is not known, but there is
disturbance of the facial nerve with swelling during its course in
the facial canal leading to compression and ischemia of the nerve.
It resolves spontaneously in 70 - 80 percent of cases, but the
recovery may be prolonged and residual disability and disfigurement
may persist. Treatments used include corticosteroids and surgical
decompression of the facial nerve.
Treatment of Bell's palsy remains
controversial. Surgical decompression has not produced any better
outcome than spontaneous resolution of the palsy. Several
prospective and retrospective studies suggest strongly that
corticosteroids are beneficial but no definitive study has been done
to prove the value of corticosteroids.
Litavrin et al (1985) reported on HBO as a part
of multimodal therapy for Bell's palsy in 42 patients. A further 29
patients with a similar clinical picture were treated by
conventional methods and served as controls. The authors concluded
that the addition of HBO to other methods increases the efficacy of
the treatment, and reduces the period needed for restoration of the
function of the damaged nerve.
Nakata(1986) treated 66 patients with Bell's
palsy using HBO. In 54 patients for whom the treatment was started
within 2 weeks after onset, 45 (83%) recovered completely, 7
recovered partially and 2 did not recover. All the patients whose
EMG showed evidence of neuropraxia recovered completely. Those with
incomplete denervation also recovered, but their recovery period was
much longer. This pattern of recovery is better than could be
predicted from the natural history of the disease, or as a result of
other treatments such as steroids and surgical decompression.
Racic et al (1997) compared the therapeutic
effects of HBO with those of prednisone treatment in 79 patients
with Bell's palsy who were randomly assigned either to the HBO
treated group (n=42) or to the prednisone treated group (n=37). The
HBO group was exposed to 2.8 ata of 100% oxygen for 60 min. twice a
day, 5 days a week and was given a placebo orally. The prednisone
group was exposed to 2.8 ata of 7% O2 (equivalent to 21% O2 in air
at normal pressure) following the same schedule as the HBO group;
prednisone was given orally (total of 450mg in 8 days). Subjects
from both groups were treated in the hyperbaric chamber for up to 30
sessions or to complete recovery and were followed up for 9 months.
At the end of the follow-up period, 95.2% of subjects treated with
HBO and 75.7% of subjects treated with prednisone recovered
completely. The average time to complete the recovery in the HBO
group was 22 days as compared to 34.4 days in the control group
(p<0.00l). These results suggest that HBO is more effective than
prednisone in treatment of Bell's palsy.
These statistics are from the Textbook of
Hyperbaric Medicine by K. K. Jain, 3rd Revised Edition.
HBO has been proven effective in the treatment
of Bell's palsy and in conjunction with other treatments, helps to
prevent permanent facial disfigurement.