COVID-19 Infection May Be Associated with Unique Manifestation of Facial Nerve Paralysis/Palsy

by Linda Kossoff •

What are the clinical characteristics and recovery outcomes among patients affected by facial nerve paralysis/palsy (FNP) following COVID-19 infection?

BOTTOM LINE

FNP is a possible presentation following COVID-19 infections and is associated with both Guillain-Barré Syndrome (GBS) patients and non-GBS patients.

BACKGROUND: FNP is a debilitating condition whose etiology is broad, although viral-associated Bell’s palsy is considered the most prevalent contributor. Incidence of FNP has increased since the onset of the COVID-19 pandemic. Numerous case reports have described GBS, which is linked to viral infections, as a sequela of COVID-19 infections.

STUDY DESIGN: Systematic review.

SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.

SYNOPSIS: Researchers mined multiple databases from inception to November 2021 to identify studies reporting FNP in adult and/or pediatric patients actively infected with COVID-19. A total of 53 studies representing 72 patients met inclusion criteria. Within this group, 30 patients were diagnosed with GBS and 42 were non-GBS patients. More patients in the non-GBS group presented with unilateral FNP as compared to the GBS group (88% vs 26%, respectively). Patients with GBS presented with a more delayed onset of FNP with more severe symptoms and worse facial nerve outcomes than non- GBS patients. Non-GBS patients had a higher proportion of bilateral FNP (75%) compared to Bell’s palsy patients, suggesting an etiology different from Bell’s palsy with differing presentation and prognosis. Most non-GBS patients received steroids (50%), antivirals (29%), antibiotics (21%), or no treatment (21%). Most GBS patients received intravenous immunoglobulins (80%), hydroxychloroquine (42.9%), or plasmapheresis (26.7%). Complete recovery was achieved in 67% of non-GBS patients (median 11 days) compared to 17% of GBS patients (median 30 days). Study limitations included variability in length of patient follow-up.

CITATION: Namavarian A, Eid A, Ziai H, et al. Facial nerve paralysis and COVID-19: A systematic review. Laryngoscope. 2023;133:1007–1013.