The impact of frailty on facial nerve recovery following Bell's palsy.

OBJECTIVES: Patients with Bell's palsy, the sudden onset of facial paralysis, have variable recovery. Frailty has been recognized as an important factor in predicting recovery. This study investigated the relationship between frailty and facial nerve recovery in Bell's palsy patients.

METHODS: A retrospective review was conducted on 95 Bell's palsy patients at a single institution's Department of Otolaryngology from 2014 to 2023. A clinically relevant facial nerve recovery was defined as a House-Brackmann (HB) score decrease>1 between the initial and most recent visit. Patients without follow-up visits or initial HB scores <3 were excluded. Frailty was measured by modified frailty index-5 (mFI-5) at the time of Bell's palsy diagnosis. Elderly patients were those over 65 years at presentation (n = 29). Frail patients had mFI-5 > 1 (n = 8). Chi-squared analyses, Fisher's exact tests, and logistic regression models were conducted in SPSS.

RESULTS: The analytic sample included 95 patients (median age = 56.8 years, IQR = 24.1) presenting with an initial HB score > 2. 36 % of patients' HB scores decreased by ≥2 within the follow-up period. Frailty (unadjusted Odds Ratio (OR) = 6.3, 95 % CI = [1.2, 33.1], p = .023) was associated with facial nerve recovery while age was not (unadjusted OR = 1.07, 95 % CI = [0.44, 2.59], p = .889). The mFI-5 adjusted OR was 8.43 (95 % CI = [1.38, 51.4], p = .021) when adjusting for age, gender, treatment modality, access to care, and follow-up duration in a logistic regression.

CONCLUSIONS: Frailty correlated with enhanced facial nerve recovery after Bell's palsy in this cohort; age was not significantly associated. Further investigation into factors associated with frailty, including increased surveillance and treatment frequency, is warranted.