Objective: Acute facial paralysis (AFP) is one of the most common complaints of patients who were admitted to the otolaryngology emergency clinics. It is important to diagnose and provide accurate treatment for AFP because misdiagnosis or late treatment may result with permanent unwanted outcomes. The aim of the present study was to investigate the usefulness of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients diagnosed with Bell’s palsy (BP) with or without diabetes for the differential diagnosis and alternative treatment modalities of patients with BP. Methods: Patients who were admitted to the Kartal Dr. Lutfi Kırdar Training and Research Hospital emergency department with a complaint of acute peripheral facial paralysis diagnosed with BP between January 2013 and February 2017 were evaluated retrospectively. Eighteen patients with BP and 17 patients with BP and type 2 diabetes mellitus (T2DM) were included in the study. Results: Thirty-five patients diagnosed with facial paralysis were evaluated. It was statistically significant that the number of diabetic females with BP was higher than that of males (p=0.035). Seventeen patients with BP and 18 patients with T2DM and BP were evaluated, and there was no statistical significance between both groups’ NLR and PLR values. Conclusion: There was no statistically significant difference between NLR and PLR between patients with BP with T2DM and non-DM.
Amaç: Akut fasiyal paralizi (AFP) kulak burun boğaz acil polikliniğine yapılan başvurular arasında sık görülen nedenlerden birisidir. Tanısını koymak ve tedavisini olabildiğince hızlı verebilmek kalıcı hasarların oluşmasını en aza indirecek en önemli yoldur. Bu çalışmanın amacı acil servise akut tek taraflı periferik fasiyal paralizi ile başvuran Bell paralizisi (BP) tanısı alan ve tip 2 diyabeti (T2DM) olan ve olmayan hastalarda nötrofil-lenfosit oranı (NLR) ve trombosit-lenfosit oranının (PLR) belirlenerek ayırıcı tanı ve alteranatif tedavi protokolleri oluşturmak olarak belirlenmiştir. Gereç ve Yöntem: Ocak 2016 ile Şubat 2017 arasında Kartal Dr. Lütfi Kırdar Eğitim ve Araştırma Hastanesi acil servise başvuran ve KBB Acil Kliniği’ne yönlendirilen hastalar geriye dönük olarak tarandı. On yedi BP tanısı almış hasta, 18 BP tanısı almış ve bilinen tip 2 diyabeti olan hasta çalışmaya dahil edildi. Bulgular: Çalışmaya alınan 35 hastanın 21’i erkek, 16’sı kadındır. Yirmi bir erkeğin yedisinde T2DM varken 16 kadının 11’inde T2DM rastlanmıştır. T2DM mevcut olan 18 fasyal paralizi hastası ve DM olmayan 17 hastanın NLR’si ve PLR’si arasındaki fark istatistiksel olarak anlamlı değildir (p=0.2348). Sonuç: Bell paralizisi olan T2DM hastaları ile diyabetik olmayan BP hastalarının NLR ve PLR değerleri arasında istatistiksel olarak anlamlı fark izlenmemiştir
1. Cai Z, Li H, Wang X, Niu X, Ni P, Zhang W, et al. Prognostic factors of Bell’s palsy and Ramsay Hunt syndrome. Medicine (Baltimore) 2017;96:e5898.
2. Hohman MH, Hadlock TA. Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center. Laryngoscope 2014;124:E283–93.
3. Volk GF, Klingner C, Finkensieper M, Witte OW, Guntinas-Lichius O. Prognostication of recovery time after acute peripheral facial palsy: a prospective cohort study. BMJ Open. 2013;3. pii: e003007.
4. Morris AM, Deeks SL, Hill MD, Midroni G, Goldstein WC, Mazzulli T, et al. Annualized incidence and spectrum of illness from an outbreak investigation of Bell’s palsy. Neuroepidemiology 2002;21:255–61.
5. McCaul JA, Cascarini L, Godden D, Coombes D, Brennan PA, Kerawala CJ. Evidence based management of Bell’s palsy. Br J Oral Maxillofac Surg 2014;52:387–91.
6. Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002:4–30.
7. Yanagihara N, Honda N, Hato N, Murakami S. Edematous swelling of the facial nerve in Bell’s palsy. Acta Otolaryngol 2000;120:667–71.
8. Kefalidis G, Riga M, Argyropoulou P, Katotomichelakis M, Gouveris C, Prassopoulos P, et al. Is the width of the labyrinthine portion of the fallopian tube implicated in the pathophysiology of Bell’s palsy?: a prospective clinical study using computed tomography. Laryngoscope 2010;120:1203–7.
9. Gantz BJ1, Rubinstein JT, Gidley P, Woodworth GG. Surgical management of Bell’s palsy. Laryngoscope 1999;109:1177–88.
10. Eryilmaz A, Basal Y, Tosun A, Kurt Omurlu I, Basak S. The neutrophil to lymphocyte ratios of our pediatric patients with Bell’s palsy. Int J Pediatr Otorhinolaryngol 2015;79:2374–7.
11. Uslu AU, Küçük A, Şahin A, Ugan Y, Yılmaz R, Güngör T, et al. Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil-lymphocyte ratio and platelet-lymphocyte ratio. Int J Rheum Dis 2015;18:731–5.
12. Chung JH, Lim J, Jeong JH, Kim KR, Park CW, Lee SH. The significance of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in vestibular neuritis. Laryngoscope 2015;125:E257–61.
13. Toprak C, Tabakci MM, Simsek Z, Arslantas U, Durmus HI, Ocal L, et al. Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention. Postepy Kardiol Interwencyjnej 2015;11:288–97.
14. Aldemir MN, Turkeli M, Simsek M, Yildirim N, Bilen Y, Yetimoglu H, et al. Prognostic Value of Baseline Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratiosin Local and Advanced Gastric Cancer Patients. Asian Pac J Cancer Prev 2015;16:5933–7.
15. Danese E, Lippi G, Montagnana M. Red blood cell distribution width and cardiovascular diseases. J Thorac Dis 2015;7:E402–11.
16. Lontchi-Yimagou E, Sobngwi E, Matsha TE, Kengne AP. Diabetes mellitus and inflammation. Curr Diab Rep 2013;13:435–44.
17. Yilmaz M, Tarakcioglu M, Bayazit N, Bayazit YA, Namiduru M, Kanlikama M. Serum cytokine levels in Bell’s palsy. J Neurol Sci 2002;197:69–72.
18. Lou M, Luo P, Tang R, Peng Y, Yu S, Huang W, et al. Relationship between neutrophil-lymphocyte ratio and insulin resistance in newly diagnosed type 2 diabetes mellitus patients. BMC Endocr Disord 2015;15:9.
19. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 2013;11:55–9.
20. Wang D, Yang JX, Cao DY, Wan XR, Feng FZ, Huang HF, et al. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma. Onco Targets Ther 2013;6:211–6.
21. Seo YJ, Park YA, Bong JP, Park DJ, Park SY. Predictive value of neutrophil to lymphocyte ratio in first-time and recurrent idiopathic sudden sensorineural hearing loss. Auris Nasus Larynx 2015;42:438–42.
22. Atan D, İkincioğulları A, Köseoğlu S, Özcan KM, Çetin MA, Ensari S, et al. New Predictive Parameters of Bell’s Palsy: Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio. Balkan Med J 2015;32:167–70.
23. Ulu S, Ulu MS, Bucak A, Ahsen A, Yucedag F, Aycicek A. Neutrophil-to-lymphocyte ratio as a new, quick, and reliable indicator for predicting diagnosis and prognosis of idiopathic sudden sensorineural hearing loss. Otol Neurotol 2013;34:1400–4.
24. Özler GS, Günak G. Neutrophil-lymphocyte ratio: a new predictive and prognostic factor in patients with Bell palsy. J Craniofac Surg 2014;25:944–5.
25. Xu T, Weng Z, Pei C, Yu S, Chen Y, Guo W, et al. The relationship between neutrophil-to-lymphocyte ratio and diabetic peripheral neuropathy in Type 2 diabetes mellitus. Medicine (Baltimore) 2017;96:e8289.