The Laryngoscope C 2013 The American Laryngological, V
Rhinological and Otological Society, Inc.
Neutrophil-to-Lymphocyte Ratio as a Novel-Potential Marker for Predicting Prognosis of Bell Palsy Abdulkadir Bucak; Sahin Ulu; Serdar Oruc; Fatih Yucedag, PhD; Mustafa Said Tekin, MD; Fatıma Karakaya, MD; Abdullah Aycicek Objectives/Hypothesis: Bell palsy can be defined as an idiopathic, acute, facial nerve palsy. Although the pathogenesis of Bell palsy is not fully understood, inflammation seems to play important role. Neutrophil-to-lymphocyte (NLR) ratio was defined as a novel potential marker to determine inflammation and it is routinely measured in peripheral blood. Our goal was to investigate the relationship between Bell palsy and inflammation by using NLR. Study Design: Retrospective study. Methods: The 54 patients who were followed up for Bell palsy for a period of 1 to 3 years, along with 45 age- and sexmatched controls, were included in the study. An automated blood cell counter was used for NLR measurements. All patients were treated with prednisone, 1 mg/kg per day with a progressive dose reduction. Patients were classified according to the House-Brackmann grading system at posttreatment period. Those with House-Brackmann grade I and grade II were regarded as satisfactory recovery; and those with House-Brackmann grade III to grade VI were regarded as nonsatisfactory recovery. Results: The mean NLR and neutrophil values in patients with Bell palsy were significantly higher than in the control group (P 5 0.001 and P < 0.001, respectively). In addition, NLR levels were higher in nonsatisfactory recovered patients compared with satisfactory recovered ones (P < 0.001). Conclusion: This is the first study investigating the relationship between NLR levels and Bell palsy and its prognosis. Our result suggest that while evaluating Bell palsy patients, NLR might be taken into account as a novel potential marker to predict the patients’ prognosis. Key Words: Facial nerve, Bell palsy, prognosis, inflammatory marker, neutrophil, neutrophil-to-lymphocyte ratio. Level of Evidence: 3b. Laryngoscope, 124:1678–1681, 2014
INTRODUCTION The pathogenesis of Bell palsy is not fully understood; however, inflammation and viral infections seem to play an important role.1,2 Inflammatory reaction compresses the facial nerve in the fallopian canal, particularly in the labyrinthine segment.3 Because it is difficult to predict a prognosis in the early stage of the disease, a variety of clinical tests have been introduced. Electrophysiological tests are in use as the main prognostic test for facial nerve paralysis. These tests include electroneuronography (ENoG), nerve excitability test, electromyography (EMG), blink reflex, and the stapedial muscle reflex. Among these, ENoG and EMG usefulness for predicting the prognosis has been proven.4–6 However, most of these tests must take place
From the Department of Otolaryngology (A.B., S.U., F.Y., M.S.T., A.A.); and Department of Neurology (S.O., F.K.), Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey. Editor’s Note: This Manuscript was accepted for publication November 26, 2013. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Abdulkadir Bucak, Assist. Professor, Department of Otolaryngology, Afyon Kocatepe University, Faculty of Medicine, Ali Cetinkaya Kampusu Tıp Fakultesi Izmir Karayolu 8.km 03200, Afyonkarahisar, Turkey. E-mail: [email protected] DOI: 10.1002/lary.24551
Laryngoscope 124: July 2014
1678
during a specific time period; thus, they are not suitable for practical use. White blood cell (WBC) count and its subtypes are known as classic inflammatory markers, especially in cardiovascular diseases.7 Neutrophil-to-lymphocyte ratio (NLR) has been defined as a novel potential marker to determine inflammation and can be measured routinely in peripheral blood without any cost. Also, in recent studies NLR has been introduced as a potential marker to determine inflammation in cardiac and noncardiac disorders.8–12 To our knowledge, NLR values in Bell palsy and role in the prognosis of this disease have not been investigated. Based on this background, we aimed to investigate the relationship between Bell palsy and inflammation by using NLR, which is a new method that is measured routinely in complete blood count (CBC) tests without any cost.
MATERIALS AND METHODS The present study was conducted in the Otorhinolaryngology and Neurology Clinics of Afyon Kocatepe University Faculty of Medicine Hospital between January 2010 and March 2013. The study protocol was approved by the ethics committee of Afyon Kocatepe University Faculty of Medicine and was conducted in accordance with the ethical principles described by the Declaration of Helsinki. A uniform consent was obtained from all the groups. The patient files were scanned; 54 patients who were followed up due to Bell palsy for a period of 1 to 3 years by otorhinolaryngology and neurology clinics and 45
Bucak et al.: Neutrophil-to-Lymphocyte for Prognosis of Bell Palsy
TABLE I. The Characteristics and the Laboratory Data of the Groups. Mean Value Variables
Patient Group
Control Group
P Value
43.11 6 18.12
48.33 6 5.65
NS
27 (50)
18 (40)
NS
Neutrophil
27 (50) 5.86 6 2.38
27 (60) 3.94 6 1.12
Rhinological and Otological Society, Inc.
Neutrophil-to-Lymphocyte Ratio as a Novel-Potential Marker for Predicting Prognosis of Bell Palsy Abdulkadir Bucak; Sahin Ulu; Serdar Oruc; Fatih Yucedag, PhD; Mustafa Said Tekin, MD; Fatıma Karakaya, MD; Abdullah Aycicek Objectives/Hypothesis: Bell palsy can be defined as an idiopathic, acute, facial nerve palsy. Although the pathogenesis of Bell palsy is not fully understood, inflammation seems to play important role. Neutrophil-to-lymphocyte (NLR) ratio was defined as a novel potential marker to determine inflammation and it is routinely measured in peripheral blood. Our goal was to investigate the relationship between Bell palsy and inflammation by using NLR. Study Design: Retrospective study. Methods: The 54 patients who were followed up for Bell palsy for a period of 1 to 3 years, along with 45 age- and sexmatched controls, were included in the study. An automated blood cell counter was used for NLR measurements. All patients were treated with prednisone, 1 mg/kg per day with a progressive dose reduction. Patients were classified according to the House-Brackmann grading system at posttreatment period. Those with House-Brackmann grade I and grade II were regarded as satisfactory recovery; and those with House-Brackmann grade III to grade VI were regarded as nonsatisfactory recovery. Results: The mean NLR and neutrophil values in patients with Bell palsy were significantly higher than in the control group (P 5 0.001 and P < 0.001, respectively). In addition, NLR levels were higher in nonsatisfactory recovered patients compared with satisfactory recovered ones (P < 0.001). Conclusion: This is the first study investigating the relationship between NLR levels and Bell palsy and its prognosis. Our result suggest that while evaluating Bell palsy patients, NLR might be taken into account as a novel potential marker to predict the patients’ prognosis. Key Words: Facial nerve, Bell palsy, prognosis, inflammatory marker, neutrophil, neutrophil-to-lymphocyte ratio. Level of Evidence: 3b. Laryngoscope, 124:1678–1681, 2014
INTRODUCTION The pathogenesis of Bell palsy is not fully understood; however, inflammation and viral infections seem to play an important role.1,2 Inflammatory reaction compresses the facial nerve in the fallopian canal, particularly in the labyrinthine segment.3 Because it is difficult to predict a prognosis in the early stage of the disease, a variety of clinical tests have been introduced. Electrophysiological tests are in use as the main prognostic test for facial nerve paralysis. These tests include electroneuronography (ENoG), nerve excitability test, electromyography (EMG), blink reflex, and the stapedial muscle reflex. Among these, ENoG and EMG usefulness for predicting the prognosis has been proven.4–6 However, most of these tests must take place
From the Department of Otolaryngology (A.B., S.U., F.Y., M.S.T., A.A.); and Department of Neurology (S.O., F.K.), Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey. Editor’s Note: This Manuscript was accepted for publication November 26, 2013. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Abdulkadir Bucak, Assist. Professor, Department of Otolaryngology, Afyon Kocatepe University, Faculty of Medicine, Ali Cetinkaya Kampusu Tıp Fakultesi Izmir Karayolu 8.km 03200, Afyonkarahisar, Turkey. E-mail: [email protected] DOI: 10.1002/lary.24551
Laryngoscope 124: July 2014
1678
during a specific time period; thus, they are not suitable for practical use. White blood cell (WBC) count and its subtypes are known as classic inflammatory markers, especially in cardiovascular diseases.7 Neutrophil-to-lymphocyte ratio (NLR) has been defined as a novel potential marker to determine inflammation and can be measured routinely in peripheral blood without any cost. Also, in recent studies NLR has been introduced as a potential marker to determine inflammation in cardiac and noncardiac disorders.8–12 To our knowledge, NLR values in Bell palsy and role in the prognosis of this disease have not been investigated. Based on this background, we aimed to investigate the relationship between Bell palsy and inflammation by using NLR, which is a new method that is measured routinely in complete blood count (CBC) tests without any cost.
MATERIALS AND METHODS The present study was conducted in the Otorhinolaryngology and Neurology Clinics of Afyon Kocatepe University Faculty of Medicine Hospital between January 2010 and March 2013. The study protocol was approved by the ethics committee of Afyon Kocatepe University Faculty of Medicine and was conducted in accordance with the ethical principles described by the Declaration of Helsinki. A uniform consent was obtained from all the groups. The patient files were scanned; 54 patients who were followed up due to Bell palsy for a period of 1 to 3 years by otorhinolaryngology and neurology clinics and 45
Bucak et al.: Neutrophil-to-Lymphocyte for Prognosis of Bell Palsy
TABLE I. The Characteristics and the Laboratory Data of the Groups. Mean Value Variables
Patient Group
Control Group
P Value
43.11 6 18.12
48.33 6 5.65
NS
27 (50)
18 (40)
NS
Neutrophil
27 (50) 5.86 6 2.38
27 (60) 3.94 6 1.12
