Facial and hearing outcomes in transmastoid nerve decompress
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Facial nerve decompression is a salvage treatment for Bell’s palsy patients for whom a poor prognosis is anticipated with standard medical treatment. The transmastoid approach is a frequently performed approach, but it remains unknown if this surgery is effective when the ossicular chain is preserved. This study aimed to determine the efficacy of facial nerve decompression using the transmastoid approach in Bell’s palsy.

This retrospective study included patients who had undergone transmastoid facial nerve decompression with ossicular chain preservation and patients who met the criteria for surgery, but received only medical treatment at a single centre.

The recovery rate to House Brackmann grade I in the decompression group in the early phase (less than 18 days after onset) was higher than that of the medical treatment group, although the difference was not significant (70% vs. 47%). However, within this early surgery group, a subgroup of cases with more than 95% facial nerve degeneration demonstrated a significant improvement in recovery rate (73% vs. 30%). Among surgeries performed in the late phase (more than 19 days), only a subgroup with more than 95% facial nerve degeneration was available for analysis, and the difference in recovery rate was not significant compared with medical treatment alone (26% vs. 30%). Post-surgical hearing evaluation demonstrated that average hearing deterioration was 1.3 dB which was non-significant, suggesting this procedure does not cause hearing loss.

Transmastoid facial nerve decompression with ossicular chain preservation in the early phase after symptom onset is an effective salvage treatment for severe Bell’s palsy with more than 95% facial neve degeneration.

Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/coa.13671
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