Effect of Adjuvant Hyperbaric Oxygen Therapy on Bells Palsy Outcome

Study Overview
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Brief Summary
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This is a randomized, single blinded, non-placebo controlled that will compare one group of Bells Palsy patients receiving the current standard of care including oral corticosteroids and oral antivirals against an experimental group receiving the current standard of care in addition to hyperbaric oxygen therapy. Outcome assessment will be based on both objective analyses of facial movements as well as subjective quality of life scales.

Official Title
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Effect of Adjuvant Hyperbaric Oxygen Therapy on Bells Palsy Outcome

Conditions
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Bell Palsy

Intervention / Treatment
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* Drug: Oral Corticosteroids
* Drug: Oral antivirals
* Device: Hyperbaric Oxygen Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years or older exhibiting unilateral facial paralysis progressing to completion in 4 days or less. Exclusion Criteria: No patients from vulnerable populations as listed above will be included. Subjects must be able to travel to NYULMC continually during the first 12 months following enrollment. During the initial visit candidates must have no associated clinical signs or symptoms consistent with other causes of facial palsy. This includes but is not limited to: auricular papules, skin rashes, parotid masses, craniofacial trauma, and the presence of other cranial or distal neuropathies excluding facial numbness, change in taste, and/or hyperacusis. Patients with atypical presentations will be referred for cross-sectional imaging and excluded. Patients with histories consistent with possible recent tick exposure, rashes, headaches, or excessive fatigue will be serologically tested for Lyme disease and excluded if it returns positive. Pneumothorax within the last two years is the only absolute medical exclusion criteria (FF). Patients who are epileptics, or are claustrophobic, will be carefully counseled on the risks of HBOT before being allowed to enroll. Patients with severe comorbidities will undergo evaluation by their primary care doctor and require physician approval prior to enrollment.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Standard of Care Therapy<br>Reference Therapy | Drug: Oral Corticosteroids<br>* Prednisone 10 day taper: 60mg for 5 days, then taper for five days to 0mg<br>Drug: Oral antivirals<br>* acyclovir 400mg: one pill 4 times daily for 7 days<br>|
| Experimental: Standard of Care + HOTB<br>Reference therapy in addition to Hyperbaric Oxygen Therapy | Drug: Oral Corticosteroids<br>* Prednisone 10 day taper: 60mg for 5 days, then taper for five days to 0mg<br>Drug: Oral antivirals<br>* acyclovir 400mg: one pill 4 times daily for 7 days<br>Device: Hyperbaric Oxygen Therapy<br>* 2.4atm administered for twice daily dives for 5 days, 10 dives total. To be begun in the first 1 week after onset of paralysis.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the percentage of subjects that return to baseline facial function 1 year following the onset of paralysis Standard of Care Group |  | 3, 6 and 12 months | 
| Change in the percentage of subjects that return to baseline facial function 1 year following the onset of paralysis Standard of Care + Hyperbaric Oxygen Therapy on Bells Palsy (HBOT) Group |  | 3, 6 and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short Form 36 (SF-36) Score Standard of Care Group | As part of the Medical Outcomes Study (MOS), a multi-year, multi-site study to explain variations in patient outcomes, RAND developed the 36-Item Short Form Health Survey (SF-36). The eight sections are: vitality physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning and mental health | 3, 6 and 12 months | 
| Short Form 36 (SF-36) Score Standard of Care + HBOT | As part of the Medical Outcomes Study (MOS), a multi-year, multi-site study to explain variations in patient outcomes, RAND developed the 36-Item Short Form Health Survey (SF-36). The eight sections are: vitality physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning and mental health | 3, 6 and 12 months | 
| Facial Clinimetric Evaluation Scale (FaCE) Score Standard of Care Group | Used to assess facial impairment and disability after facial paralysis. It involves 15 statements, each using a five-item Likert scale. A participant circles the most appropriate response to a given statement, whereby 1 corresponds to the lowest function and 5 corresponds to the highest function. Statements are grouped into six independent domains: social function, facial movement, facial comfort, oral function, eye comfort, and lacrimal control. A score from 0 (worst) to 100 (best) is calculated. | 3, 6 and 12 months | 
| Facial Clinimetric Evaluation Scale (FaCE) Score Standard of Care + HBOT | Used to assess facial impairment and disability after facial paralysis. It involves 15 statements, each using a five-item Likert scale. A participant circles the most appropriate response to a given statement, whereby 1 corresponds to the lowest function and 5 corresponds to the highest function. Statements are grouped into six independent domains: social function, facial movement, facial comfort, oral function, eye comfort, and lacrimal control. A score from 0 (worst) to 100 (best) is calculated. | 3, 6 and 12 months | 
| Facial Disability Index (FDI) Score Standard of Care Group | Assesses facial neuromuscular dysfunction. Consists of 10 questions regarding physical function scoring difficulty on a scale of 2-5; 5 being no difficulty and 2 being much difficulty | 3, 6 and 12 months | 
| Facial Disability Index (FDI) Score Standard of Care + HBOT | Assesses facial neuromuscular dysfunction. Consists of 10 questions regarding physical function scoring difficulty on a scale of 2-5; 5 being no difficulty and 2 being much difficulty | 3, 6 and 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Oxygen Therapy, Bells Palsy