CC BY 4.0 · Int Arch Otorhinolaryngol 2025; 29(01): s00441789197
DOI: 10.1055/s-0044-1789197
Original Research

Is There an Association between Bell Palsy in Pediatric Patients and COVID-19?

1   Department of Otorhinolaryngology, Head and Neck Surgery, Kafrelsheikh University Hospital, Faculty of Medicine, Kafrelsheikh University, Kafr El Sheikh, Kafr El Sheikh Governorate, Egypt
,
Saad Elzayat
1   Department of Otorhinolaryngology, Head and Neck Surgery, Kafrelsheikh University Hospital, Faculty of Medicine, Kafrelsheikh University, Kafr El Sheikh, Kafr El Sheikh Governorate, Egypt
,
Abeer Salamah
2   Department of Pediatrics, Faculty of Medicine, Kafrelsheikh University, Kafr El Sheikh, Kafr El Sheikh Governorate, Egypt
,
Ali Gamal
1   Department of Otorhinolaryngology, Head and Neck Surgery, Kafrelsheikh University Hospital, Faculty of Medicine, Kafrelsheikh University, Kafr El Sheikh, Kafr El Sheikh Governorate, Egypt
,
Shimaa Elgamal
3   Department of Neuropsychiatry, Faculty of Medicine, Kafrelsheikh University, Kafr El Sheikh, Kafr El Sheikh Governorate, Egypt
,
Ahmed El-Sobki
4   Department of Otorhinolaryngology, Faculty of Medicine, Mansoura University, Mansoura, Dakahlia Governorate, Egypt
› Institutsangaben
Funding The authors declare that they did not receive funding from agencies in the public, private or non-profit sectors to conduct the present study.

Abstract

Introduction Bell palsy (BP) is an acquired, idiopathic facial palsy linked to lower motor neuron malfunction of the seventh cranial nerve. Several studies have identified BP as one of the many neuropathies that coronavirus disease 2019 (COVID-19) patients have developed, while other studies disagree.

Objective To study if there is an association between BP in pediatric patients and COVID-19, and to examine the pattern of recovery in all pediatric cases of BP during the COVID-19 pandemic.

Methods We performed a prospective cohort study on pediatric patients with acute onset unilateral facial weakness of unknown etiology (BP) during the pandemic period. All included patients were submitted to a reverse transcription-polymerase chain reaction (RT-PCR) test through nasopharyngeal and oropharyngeal swabs for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of the BP diagnosis.

Results No significant differences were found regarding COVID-19 infection and recovery from BP at the first, third, or sixth months of follow-up. According to the results, it seems that there is no association between COVID-19 infection and facial palsy; however, the patients infected with COVID-19 in the sample experienced a rapid, early recovery from BP. The mean incidence of BP in 5 years (2017–2021) was of 1.73/100 thousand individuals, with a statistically insignificant change throughout the years.

Conclusion We were not able to show any association between BP and COVID-19. The patients underwent follow-up for up to 6 months, and we studied their patterns of recovery from BP, which were like those observed before the pandemic.

Ethical Approval

All procedures involving human participants in the present study followed the ethical standards of the institutional research editorial boards and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


Consent to Participate

Explanations were given, and informed written consent was obtained from the parents of the included patients.


Consent for Publication

Formal consent was provided by the parents of the included patients to share and publish their data in the present study.


Availability of Data and Materials

The datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request.


Authors' Contributions

MD: final revision, methodology, and data collection; SZ: methodology and the idea to perform the study; AS: data collection, review, writing and editing of the final draft; SE: data collection and revision; AG: data collection; and AS: methodology and final revision.




Publikationsverlauf

Eingereicht: 19. Juni 2023

Angenommen: 30. Juni 2024

Artikel online veröffentlicht:
23. Januar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Bibliographical Record
Mohamed E. El-Deeb, Saad Elzayat, Abeer Salamah, Ali Gamal, Shimaa Elgamal, Ahmed El-Sobki. Is There an Association between Bell Palsy in Pediatric Patients and COVID-19?. Int Arch Otorhinolaryngol 2025; 29: s00441789197.
DOI: 10.1055/s-0044-1789197
 
  • References

  • 1 Zhang W, Xu L, Luo T, Wu F, Zhao B, Li X. The etiology of Bell's palsy: a review. J Neurol 2020; 267 (07) 1896-1905
  • 2 Theophanous C, Santoro JD, Itani R. Bell's palsy in a pediatric patient with hyper IgM syndrome and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Brain Dev 2021; 43 (02) 357-359
  • 3 Psillas G, Antoniades E, Ieridou F, Constantinidis J. Facial nerve palsy in children: A retrospective study of 124 cases. J Paediatr Child Health 2019; 55 (03) 299-304
  • 4 Lorch M, Teach SJ. Facial nerve palsy: etiology and approach to diagnosis and treatment. Pediatr Emerg Care 2010; 26 (10) 763-769 , quiz 770–773
  • 5 Khan A, Hussain N, Gosalakkal J. Bells palsy in children–a review. J Pediatr Sci. 2011; 3 (02) 2-11
  • 6 Shi Y, Wang G, Cai XP. et al. An overview of COVID-19. J Zhejiang Univ Sci B 2020; 21 (05) 343-360
  • 7 Elsherief H, Amer M, Abdel-Hamid AS, El-Deeb ME, Negm A, Elzayat S. The Pattern of Anosmia in Non-hospitalized Patients in the COVID-19 Pandemic: A Cross-sectional Study. Int Arch Otorhinolaryngol 2021; 25 (03) e334-e338
  • 8 Zhou Z, Kang H, Li S, Zhao X. Understanding the neurotropic characteristics of SARS-CoV-2: from neurological manifestations of COVID-19 to potential neurotropic mechanisms. J Neurol 2020; 267 (08) 2179-2184
  • 9 Mao L, Jin H, Wang M. et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77 (06) 683-690
  • 10 El-Anwar MW, Elzayat S, Fouad YA. ENT manifestation in COVID-19 patients. Auris Nasus Larynx 2020; 47 (04) 559-564
  • 11 Homma Y, Watanabe M, Inoue K, Moritaka T. Coronavirus disease-19 pneumonia with facial nerve palsy and olfactory disturbance. Intern Med 2020; 59 (14) 1773-1775
  • 12 Lima MA, Silva MTT, Soares CN. et al. Peripheral facial nerve palsy associated with COVID-19. J Neurovirol 2020; 26 (06) 941-944
  • 13 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
  • 14 Eviston TJ, Croxson GR, Kennedy PG, Hadlock T, Krishnan AV. Bell's palsy: aetiology, clinical features and multidisciplinary care. J Neurol Neurosurg Psychiatry 2015; 86 (12) 1356-1361
  • 15 Drack FD, Weissert M. Outcome of peripheral facial palsy in children - a catamnestic study. Eur J Paediatr Neurol 2013; 17 (02) 185-191
  • 16 Batu ED, Özen S. Implications of COVID-19 in pediatric rheumatology. Rheumatol Int 2020; 40 (08) 1193-1213
  • 17 Yılmaz U, Cubukçu D, Yılmaz TS, Akıncı G, Özcan M, Güzel O. Peripheral facial palsy in children. J Child Neurol 2014; 29 (11) 1473-1478
  • 18 Rowhani-Rahbar A, Baxter R, Rasgon B. et al. Epidemiologic and clinical features of Bell's palsy among children in Northern California. Neuroepidemiology 2012; 38 (04) 252-258
  • 19 Rowlands S, Hooper R, Hughes R, Burney P. The epidemiology and treatment of Bell's palsy in the UK. Eur J Neurol 2002; 9 (01) 63-67
  • 20 Mutlu A, Kalcioglu MT, Gunduz AY, Bakici B, Yilmaz U, Cag Y. Does the SARS-CoV-2 pandemic really increase the frequency of peripheral facial palsy?. Am J Otolaryngol 2021; 42 (05) 103032
  • 21 Barron D, Richards O, Archer F, Abdelrazek M, Ranjan R, Omolokun O. A cluster of children with facial nerve palsy in a high prevalence area for COVID-19. BMC Pediatr 2021; 21 (01) 470
  • 22 Zammit M, Markey A, Webb C. A rise in facial nerve palsies during the coronavirus disease 2019 pandemic. J Laryngol Otol 2020; 134 (10) 1-4
  • 23 Codeluppi L, Venturelli F, Rossi J. et al. Facial palsy during the COVID-19 pandemic. Brain Behav 2021; 11 (01) e01939
  • 24 Hogg ES, Hampton T, Street I. et al. Increased incidence of idiopathic paediatric facial palsy during the coronavirus disease 2019 pandemic. J Laryngol Otol 2021; 135 (08) 668-670
  • 25 Brisca G, Garbarino F, Carta S. et al. Increased childhood peripheral facial palsy in the emergency department during COVID-19 pandemic. Pediatr Emerg Care 2020; 36 (10) e595-e596
  • 26 Srinivas CV, Kauser S, Sangoli B. The surge of Bell's palsy in COVID-pandemic era. Int J Otorhinolaryngol Head and Neck Surg. 2020; 6: 2042-2045
  • 27 Tamaki A, Cabrera CI, Li S. et al. Incidence of Bell palsy in patients with COVID-19. JAMA Otolaryngol Head Neck Surg 2021; 147 (08) 767-768
  • 28 Yoo MC, Park DC, Byun JY, Yeo SG. Clinical Prognostic Factors Associated with Good Outcomes in Pediatric Bell's Palsy. J Clin Med 2021; 10 (19) 4368
  • 29 Yoo HW, Yoon L, Kim HY. et al. Comparison of conservative therapy and steroid therapy for Bell's palsy in children. Korean J Pediatr 2018; 61 (10) 332-337
  • 30 Gupta S, Jawanda MK. Surge of Bell's Palsy in the era of COVID-19: Systematic review. Eur J Neurol 2022; 29 (08) 2526-2543
  • 31 Gupta S, Jawanda MK, Taneja N, Taneja T. A systematic review of Bell's Palsy as the only major neurological manifestation in COVID-19 patients. J Clin Neurosci 2021; 90: 284-292
  • 32 Egilmez OK, Gündoğan ME, Yılmaz MS, Güven M. Can COVID-19 cause peripheral facial nerve palsy?. SN Compr Clin Med 2021; 3 (08) 1707-1713
  • 33 Chen W-X, Wong V. Prognosis of Bell's palsy in children–analysis of 29 cases. Brain Dev 2005; 27 (07) 504-508
  • 34 Jenke AC, Stoek L-M, Zilbauer M, Wirth S, Borusiak P. Facial palsy: etiology, outcome and management in children. Eur J Paediatr Neurol 2011; 15 (03) 209-213
  • 35 Lee Y, SooYoon H, Yeo SG, Lee EH. Factors associated with fast recovery of Bell palsy in children. J Child Neurol 2020; 35 (01) 71-76
  • 36 Aslan M, Çiçek MT. Can isolated sudden sensorineural hearing loss (SSNHL) and idiopathic acute facial paralysis (Bell's palsy) be symptoms of COVID-19?. Am J Otolaryngol 2021; 42 (05) 103129
  • 37 Derin S, Derin H, Sahan M, Çaksen H. A pediatric case of ramsay hunt syndrome. Case Rep Otolaryngol 2014; 2014: 469565
  • 38 Yoo MC, Soh Y, Chon J. et al Evaluation of Factors Associated With Favorable Outcomes in Adults With Bell Palsy. JAMA Otolaryngol Head Neck Surg 2020; 146 (03) 256-263