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<p><b>New page</b></p><div>'''<span style="font-family: &#39;Times New Roman&#39;,serif; font-size: 14pt;">Systematic review suggests some evidence that HBOT improves the rate of recovery in Bell’s Palsy</span>'''<br />
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**<span style="font-family: &#39;Times New Roman&#39;,serif;">Citation:</span>'''<br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">Holland NJ, Bernstein JM, Hamilton JW. Hyperbaric oxygen therapy for Bell's palsy. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD007288.</span><br />
**<span style="font-family: &#39;Times New Roman&#39;,serif;">CLINICAL BOTTOM LINE:</span>'''<br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">Hyperbaric oxygen may improve the rate of recovery of facial palsy in moderate to severe Bell’s palsy when compared with prednisone.</span><br />
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**<span style="font-family: &#39;Times New Roman&#39;,serif;">Clinical scenario:</span>'''<br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">A patient presents with a 5 day history of significant unilateral facial weakness from Bell’s palsy.</span><br />
**<span style="font-family: &#39;Times New Roman&#39;,serif;">Three part question:</span>'''<br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">In patients with Bell’s palsy, does hyperbaric oxygen therapy improve recovery of facial nerve palsy.</span><br />
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**<span style="font-family: &#39;Times New Roman&#39;,serif;">The Study</span>'''<br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">Cochrane review (meta-analysis). Identified only one trial that was close to meeting eligibility criteria: Randomised, single blinded control trial</span><br />
**<span style="font-family: &#39;Times New Roman&#39;,serif;">The patients:</span>'''<span style="font-family: &#39;Times New Roman&#39;,serif;"> moderate to severe Bell’s Palsy within 2 weeks of onset</span><br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">Control group: (N= 37, 37 analysed) Prednisone (commencing at 40mg, weaning dose) with HBO at 2.8 atm and FiO2 0.21)</span><br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">Experimental group: (N = 42, 42 analysed) HBO at 2.8 atm and placebo tablets</span><br />
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**<span style="font-family: &#39;Times New Roman&#39;,serif;">The Evidence</span>'''<br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">See Racic 2007 (single study discussed here)</span><br />
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{| <br />
| '''<span style'''"font-family: &#39;Times New Roman&#39;,serif;">Outcome</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,serif;">Time to outcome</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,serif;">Control</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,serif;">Treatment</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,serif;">Absolute risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style'''"font-family: &#39;Times New Roman&#39;,serif;">Relative risk reduction</span>'''</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block; text-align: center;">'''<span style="font-family: &#39;Times New Roman&#39;,serif;">NNT</span>'''</span></span> <br />
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| '''<span style'''"font-family: &#39;Times New Roman&#39;,serif;">Improvement in Facial Nerve palsy</span>''' || <span style'''"display: block; text-align: center;"><span style'''"display: block;">9 months</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block;">0.76</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block;">0.95</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block;">0.19</span></span> || <span style'''"display: block; text-align: center;"><span style'''"display: block;">1.26</span></span><br><span style'''"display: block; text-align: center;"><span style'''"display: block;">1.04 to 1.53</span></span> || <span style'''"display: block; text-align: center;"><span style="display: block;">5</span></span> <br />
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|}<br />
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**<span style="font-family: &#39;Times New Roman&#39;,serif;">Comment</span>'''<br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">1. Observers of outcome were not blinded to treatment group ‘in practice’ (personal communication with Racic). </span><br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">2. Small number of patients enrolled.</span><br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">3. No study met eligibility criteria. Racic was excluded because outcome assessor was not blinded to allocation. </span><br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">4. Authors rate Racic study as producing ‘very low quality evidence’</span><br />
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**<span style="font-family: &#39;Times New Roman&#39;,serif;">Reviewed by</span>'''<br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">Dr Danielle Wood MBBS, FACEM, Visiting Medical Officer in Hyperbaric medicine</span><br />
<span style="font-family: &#39;Times New Roman&#39;,serif;">Correspondence to [[mailto:danspace@gmail.com | danspace@gmail.com]]</span><br />
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<span style="font-family: &#39;Times New Roman&#39;,serif;">Update: June 2020</span><br />
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**<span style="background-color: #ffffff; color: #7c00ff; font-size: 26px; text-align: center;">[[Neuro - miscellaneous | BACK]]</span>'''<br />
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