RESUMEN
AQFThe authors present the guidelines of the French Society of ENT and Head and Neck Surgery (SFORL) regarding the management of Bell's palsy in adults. After a literature review by a multidisciplinary workgroup, guidelines were drawn up based on retrieved articles and group-members' experience, then read over by an independent group to edit the final version. Guidelines were graded A, B, C or "expert opinion" according to decreasing level of evidence. Thorough ENT and neurological clinical examination is recommended in all patients presenting with peripheral facial palsy to confirm diagnosis of Bell's palsy. MRI with gadolinium enhancement should explore the entire course of the facial nerve, if possible within the first month. ENMG should be performed to assess prognosis for recovery. In confirmed Bell's palsy, corticosteroid therapy should be implemented as early as possible (ideally within 72h) at a dose of 1mg/kg/day for 7-10 days. Antiviral therapy should be associated to steroids in patients with severe and early-onset disease and in Ramsay-Hunt syndrome. Isolated antiviral therapy is not recommended. To date, there is no evidence that surgical facial nerve decompression provides benefit.
Asunto(s)
Parálisis de Bell/diagnóstico , Parálisis de Bell/terapia , Enfermedad Aguda , Corticoesteroides/administración & dosificación , Corticoesteroides/uso terapéutico , Antivirales/uso terapéutico , Parálisis de Bell/tratamiento farmacológico , Medios de Contraste , Descompresión Quirúrgica , Esquema de Medicación , Quimioterapia Combinada/métodos , Nervio Facial/diagnóstico por imagen , Parálisis Facial/diagnóstico , Francia , Gadolinio , Herpes Zóster Ótico/tratamiento farmacológico , Humanos , Oxigenoterapia Hiperbárica , Imagen por Resonancia Magnética , Examen Neurológico , Otolaringología , Modalidades de Fisioterapia , Pronóstico , Recuperación de la Función , Sociedades MédicasRESUMEN
Nebulization of solutions associating gomenol, dexamethasone and framycetin is very widespread in otorhinolaryngology (particularly for the treatment of actue laryngitis and post-traumatic laryngitis and rhinitis and for the tracheotomy care). A rigorous clinical evaluation is however lacking. The aim of this work was to evaluate use of such solutions in comparison with the recommendations issuing from the National Session in April 1997 on good practices for aerosol therapeutics. Stability and granulometry were studied in order to optimize processing. A new formulation and new technical methods of administration are proposed in relation to the results of this study and the national recommendations.