This week a patient came to Atlanta Hyperbaric seeking treatment for Bell’s Palsy. Hyperbaric oxygen is rarely considered as a therapeutic measure for Bell’s Palsy, but should be.
Bell’s Palsy is an acute neuropathy of the facial nerve. Here are excellent pictures of a patient with Bell’s Palsy. (Hopefully, I will soon have permission of the pictures’ owner to display the images here.) The pictures demonstrate the patient’s inability to raise his eyebrow on one side of his face or wrinkle his forehead on the same side. The pictures also show that he has difficulty closing his eye and the corner of his mouth is drooping on the same side.
The cause of Bell’s Palsy in most patients cannot be identified with confidence, although some cases are definitely caused by herpes simplex virus and other herpes viruses. Consensus opinion is that Bell’s Palsy occurs when an inflammatory condition of cranial nerve VII, i.e., the facial nerve, causes the nerve to swell within the bony confines of its course in the skull. According to Mayo Clinic, about 40,000 Americans annually develop Bell’s Palsy and it is only rarely seen in those under 15 or over 60. Most patients improve completely over a period of weeks, but some relapse and some never fully recover. Pregnancy and diabetes are risk factors. Most patients are treated with steroids. Because hyperbaric oxygen routinely diminishes swelling and improves oxygen delivery to tissue, it seems logical that hyperbaric oxygen might be useful in treating Bell’s Palsy.
To the best of my knowledge, only one controlled study has looked at the treatment of Bell’s Palsy with hyperbaric oxygen. This study was nicely designed because the comparison group was treated with prednisone and subjected to sham hyperbaric treatments. At the end of followup, the hyperbaric oxygen patients got better faster, had more complete responses, and showed better nerve excitability test results than the prednisone treated patients. This well designed study with clear cut results has been almost completely ignored in the scientific community.
Sometimes being a hyperbaric oxygen clinic director is frustrating. I can only wonder how many people are walking around with a partially paralyzed face because no one bothered to send them to a hyperbaric oxygen clinic.