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"apellidos" => "Elfarargy" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651923000699?idApp=UINPBA00004N" "url" => "/00016519/0000007500000001/v1_202401170604/S0001651923000699/v1_202401170604/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0001651923000651" "issn" => "00016519" "doi" => "10.1016/j.otorri.2023.04.005" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "1192" "copyright" => "Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Acta Otorrinolaringol Esp. 2024;75:23-30" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ARTÍCULO ORIGINAL</span>" "titulo" => "Variación de la impedancia eléctrica a lo largo de cinco años postimplantación y relación con el umbral de confort máximo (MCL) en adultos portadores de implante coclear" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "23" "paginaFinal" => "30" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Variation of electrical impedance over 5 years post-implantation and relationship with the maximum comfort level (MCL) in adults with cochlear implants" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1227 "Ancho" => 1508 "Tamanyo" => 52311 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlación entre impedancia y MCL (umbral de confort máximo) en electrodos medios en T2. Coeficiente <span class="elsevierStyleItalic">r</span> de correlación de Pearson r = -0,24 y <span class="elsevierStyleItalic">test</span> de nulidad (valor p) p = 0,033.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Clara Espina González, Antonio Morant Ventura, Ignacio Pla Gil, María Aragonés Redó, Tomás Pérez Carbonell, Jaime Marco Algarra" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Clara" "apellidos" => "Espina González" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Morant Ventura" ] 2 => array:2 [ "nombre" => "Ignacio" "apellidos" => "Pla Gil" ] 3 => array:2 [ "nombre" => "María" "apellidos" => "Aragonés Redó" ] 4 => array:2 [ "nombre" => "Tomás" "apellidos" => "Pérez Carbonell" ] 5 => array:2 [ "nombre" => "Jaime" "apellidos" => "Marco Algarra" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173573524000061" "doi" => "10.1016/j.otoeng.2024.01.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573524000061?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651923000651?idApp=UINPBA00004N" "url" => "/00016519/0000007500000001/v1_202401170604/S0001651923000651/v1_202401170604/es/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Variations in the treatment of acute peripheral facial paralysis. A nationwide survey" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "31" "paginaFinal" => "39" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Manuel Morales-Puebla, Mireya Fernández-Fournier, Antoni Plana-Blanco, Luis Lassaletta" "autores" => array:4 [ 0 => array:4 [ "nombre" => "José Manuel" "apellidos" => "Morales-Puebla" "email" => array:1 [ 0 => "josemanuel.morales@salud.madrid.org" ] "referencia" => array:5 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Mireya" "apellidos" => "Fernández-Fournier" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 2 => array:3 [ "nombre" => "Antoni" "apellidos" => "Plana-Blanco" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0045" ] ] ] 3 => array:3 [ "nombre" => "Luis" "apellidos" => "Lassaletta" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Department of Otolaryngology, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Otology Commission of the Spanish Society of Otolaryngology and Head and Neck Surgery, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Autonomous University of Madrid, School of Medicine, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Neurology Department, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Neuroepidemiology Coordinator of the Spanish Society of Neurology, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Primary Care Center of Balàfia-Pardinyes-Secà de St. Pere, Lleida, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Neurology Coordinator of the Spanish Society of Family and Community Medicine, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "University of Lleida, School of Medicine, Lleida, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Encuesta nacional sobre la variabilidad en el tratamiento de la parálisis facial periférica aguda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1342 "Ancho" => 2513 "Tamanyo" => 109910 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Antiviral therapy use in Ramsay Hunt syndrome. The percentage of use (black) and non use (grey) is shown in each specialty. AVT: antiviral therapy; RHS: Ramsay Hunt syndrome; GP: general practitioners; NRL: neurologists; ORL: otorhinolaryngologists.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Non-traumatic acute peripheral facial paralysis (APFP) is a common entity in the emergency department and outpatient clinics that can be diagnosed and treated by different medical specialties. Bell’s palsy (BP) is the most frequent cause of APFP and is defined by a unilateral, rapid facial muscle weakness or paralysis of unknown origin that can progress to its maximum severity within 72 h.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Ramsay Hunt syndrome (RHS), facial palsy associated to herpes zoster oticus infection, is another common cause of APFP.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the publication of several clinical practice guidelines (CPGs) regarding APFP in the last decade,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3–7</span></a> its management may vary substantially depending on the specialist who treats it or even between physicians of the same specialty.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Corticosteroid therapy starting within 72 h of symptom onset has been shown to improve facial palsy recovery rate and is strongly recommended. Eye care protection for patients with impaired eye closure is also standard treatment beyond discussion. Notwithstanding, there still are controversies regarding corticosteroids dose, use of antiviral therapy (AVT) in BP or recommendation of facial exercises such as chewing gum or blowing balloons for APFP (which may lead to aberrant reinnervation).</p></span><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0071">Objective</span><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to explore the variability in routine treatment of APFP between Otorhinolaryngologists (ORL), Neurologists (NRL) and General Practitioners (GP) in Spain.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Clinical practice survey</span><p id="par0020" class="elsevierStylePara elsevierViewall">An anonymous nationwide online survey consisting of seven closed-set and three open-ended questions (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), modified from Kasle’s et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> was conducted between 1st of August 2020 and 30th of November 2020. The data collected focused on the specialty of respondents and their habits using steroids, antiviral therapy, recommendations of eye care, chewing gum or puffing up balloons as facial exercises and reporting of drug side effects. They were also asked to indicate the source of recommendations on which they based their management for APFP. Sex and age of respondents were registered.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Target physicians</span><p id="par0025" class="elsevierStylePara elsevierViewall">Spanish Otorhinolaryngologists (ORL), Neurologists (NRL) and General Practitioners (GP) were studied: The survey was electronically distributed between 1st of August 2020 and 30th of November 2020 within the Spanish Society of Otorhinolaryngology and Head and Neck Surgery, the Spanish Society of Neurology, and the Spanish Society of Family and Community Medicine. A remainder email was sent on the first week of September and the first week of October.</p><p id="par0030" class="elsevierStylePara elsevierViewall">For all three specialties, both medical specialists and doctors in training (medical residents) received the survey.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Pharmacotherapy: possible treatment regimes</span><p id="par0035" class="elsevierStylePara elsevierViewall">Based on the recommendations of the consensus of CPGs of both the American Academy of Neurology and the American Academy of Otolaryngology—Head and Neck Surgery Foundation<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,4,5</span></a> and the recommendations of the facial paralysis CPG of the Spanish Society of Otorhinolaryngology (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>),<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> corticosteroids dosage was classified as underdose if the initial dosage was below 50 mg of prednisone or treatment lasted less than 10 days. Overdose was considered if the initial dosage was higher than 1 mg kg per day or if the treatment lasted more than 15 days. Different steroids have been accepted if the equivalence with prednisone had been properly calculated. Antiviral dosage was considered correct if it met the recommendations of the Spanish Agency of Medicines and Medical Devices (AEMPS)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> for RHS (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), lower or higher dosage was considered under or overdosage respectively.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">The overall trends in management of APFP were reported. Comparison of practice patterns between specialties and between specialists and residents within each specialty was made via Chi-square test or Fisher’s exact test with bilateral exact signification, as appropriate. Statistical analyses were performed using SPSS v20 (IBM Corp., Armonk, NY, USA). A p- value < 0,05 was considered statistically significative.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Global results, separated by specialty and divided in specialists and residents in each group are shown. Differences between specialists and residents has been analyzed in each specialty. Global results among specialties have been compared.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The results of the survey and its statistical significance are attached as supplementary material (Apendix A).</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Specialty, age and sex</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 1039 physicians completed the survey, of which 513 (49.4%) Otorhinolaryngologists (ORL), 304 (29.2%) General Practitioners (GP) and 222 (21.4%) Neurologists (NRL). The survey was mostly answered by specialists, with some residents responding (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Proportion of specialists and residents was similar in each specialty ranging between 87–89% and 11–13% respectively. Mean age was 44 years (25–88). 55% of the respondents were female.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Corticosteroids for APFP</span><p id="par0060" class="elsevierStylePara elsevierViewall">Globally, 98.1% of respondents agreed on using steroids for treating APFP although ORL prescribed steroids more frequently than others (99.6% ORL vs. 97.7% GP p = 0.016; ORL vs. 95% NRL p = 0.0001). The most prescribed steroid was prednisone (69.4%) followed by deflazacort (21.4%). Analyzing these results by specialty deflazacort was almost exclusively used by ORL (ORL vs. GP and ORL vs. NRL, p < 0.0001) and within ORL, specialists prescribed more deflazacort than residents (p = 0.003).</p><p id="par0065" class="elsevierStylePara elsevierViewall">When focusing on the dosage, 357 surveys (34% of ORL answers, 36% of NRL answers and 36% of GP answers) were incomplete and were not considered in the statistical analysis. Within the complete answers, 41.2% of the physicians used corticosteroids according to the CPGs recommendations, 23.4% used lower dose and 35.3% higher dose. When considering under or overdose, there were statistically significant differences between ORL vs. GP and NRL (p < 0.0001) with ORL using higher doses (48.2% ORL vs. 18.4% GP vs. 26.9% NRL) and GP lower doses than others (41.6% GP vs. 30.6% NRL vs. 10.4% ORL) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Antiviral therapy</span><p id="par0070" class="elsevierStylePara elsevierViewall">Only 12.6% of the doctors used AVT in BP routinely, 56.5% did not use it at all and 30.9% used it sometimes. ORL and NRL considered using it “sometimes” more frequently than GP (33.3% ORL vs. 23.4% GP p = 0.003; 35.6% NRL vs. GP p = 0.002) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Only 3.8% of the respondents answering “sometimes” specified when they decided to use AVT for BP, but the most frequent answers were severe palsies and pain at onset.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Although 88.6% of the respondents used AVT for RHS, 4.7% of ORL never used it, neither 11.3% of NRL nor 22.7% of GP (ORL vs. NRL p = 0,002; ORL vs. GP p < 0.0001; NRL vs. GP p = 0.001) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Significant differences in the antiviral selection were found. Acyclovir was the preferred antiviral drug for NRL (63.3% NRL vs. 27% GP p < 0.0001; 63.3% NRL vs. 31.4% ORL p < 0.0001) while GP and ORL preferred valacyclovir (55.3% GP vs. 27.7% NRL p < 0.0001; 42.1% ORL vs. 27.7% NRL p = 0.001). Famciclovir was mainly used by ORL (33.3% ORL vs. 11.9% GP p < 0.0001; ORL vs. 7.4% NRL p < 0.0001) and within ORL it was more prescribed by specialists (25.2% ORLs vs. 9.1% ORLr p = 0.006). There were no differences between specialists and residents in the usage of antiviral drugs in NRL nor GP.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Regarding AVT dosage, 312 surveys (24.7% GP, 39.9% NRL and 35.8% ORL), were considered incomplete and were not considered in the statistical analysis. Within the complete answers, 65% of the physicians used AVT according to AEMPS recommendations, 30.3% used lower dose and 4.1% higher dose. When analyzing under and overdose, the three specialties tend to underdose, NRL and ORL which underdosed more frequently than GP (28.6% NRL vs. GP 16.9% p = 0.037; 38.5% ORL vs. GP 16.9% p < 0.0001) (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">When use of drug was analysed, a higher percentage of underdosification was found when comparing acyclovir with valacyclovir and famciclovir (57.6% vs. 22% vs. 22.9%, p < 0.0001).</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Eye care</span><p id="par0095" class="elsevierStylePara elsevierViewall">There was a unanimous agreement about recommending eye care as part of the treatment for APFP (99.5%).</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Facial exercises</span><p id="par0100" class="elsevierStylePara elsevierViewall">Chewing gum and puffing up balloons was recommended by 45.4% of the participants, with GPs prescribing them more often than neurologists or ORL, and neurologists prescribing them more often than ORL (58.9% GP vs. 48.6% NRL p = 0.021; GP vs. 36.1% ORL p < 0.001; NRL vs. ORL p = 0.002). Residents recommended fewer facial exercises than specialists in the three specialties with statistically significant differences for ORL (p = 0.048) and GPs (p = 0.002).</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Learning influence</span><p id="par0105" class="elsevierStylePara elsevierViewall">Treatment recommendations were mainly based on CPGs and consensus documents, knowledge acquired during the residency was the second chosen option followed by personal experience and scientific papers. When analyzing these results between specialists and residents, residents give more importance to what has been learnt during residency (68.2 % GPs vs. 83.7% GPr p = 0.047; 70.6% NRLs vs. 96% NRLr p = 0.007; 61.9% 88.7% ORLs vs. ORLr p < 0.0001) and specialists to personal experience (39.1% GPs vs. 16.3% GPr p = 0.003; 46.7% NRLs vs. 32% NRLr p = 0.202; 51% ORLs vs. 17.7% ORLr p < 0.0001).</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Side effects</span><p id="par0110" class="elsevierStylePara elsevierViewall">Only 17% of surveys reported side effects, most of them related to corticosteroid treatment. Attendings reporting more than residents in each specialty with statistically significance within GP (13% vs 2.3%, p = 0.04) and ORL (22% vs 6.5%, p = 0.004). The most frequently reported steroid side effects were blood sugar decompensation (87 surveys), blood pressure decompensation (38 surveys), insomnia (33 surveys) and gastric intolerance (33 surveys). Less than 2% of surveys referred side effects from AVT, mainly gastric intolerance and acute renal failure. No statistical differences between the presence of side effects and the prescribed corticosteroid was found but they were less frequently reported whith deflazacort.</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">This is the first study addressing the variability in routine treatment of APFP between ORL, NRL and GP in Spain. With more than one thousand participants, these survey provides a well-balanced representation of each specialty including atendings and residents. The results of this study show a general agreement on routine use of corticosteroids and eye care as part of the treatment of APFP. Yet, differences in corticosteroids dosage, AVT prescription and recommendation of facial exercises such as chewing gum or blowings balloons have been found among specialties.</p><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Medical treatment for APFP</span><p id="par0120" class="elsevierStylePara elsevierViewall">In accordance with previously published CPGs<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4–7</span></a> > 98% of the participants of this survey agreed on using corticosteroids as part of the treatment for APFP. These results show better physicians’ adherence to guidelines than other similar studies.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,10</span></a> Kasle et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> carried out an online survey via the American Neurotology Society/American Otology Society and the American Academy of Neurology which compared the variations in treatment of BP between ORL and NRL, in total 87,9% of their participants routinely prescribed steroids. Taufique et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> designed a retrospective cohort study to analyze the adherence to ORL clinical practice guidelines in the Emergency Department at an academic tertiary care center in New York, steroids were prescribed in 94% of patients with BP.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Concerning the prescription patterns of corticosteroids, the results of this study also differ from Kasle et al’s.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> where they found that 71.9% of their respondents (89.7% ORL vs. 58% NRL) used higher corticosteroids dosage than those recommended in the CPGs, while in our study only 35.3% physicians prescribed steroids in the “overdose” range. Yet, when stratifying by specialty we obtained the same ORL preference for higher doses (48.2% ORL vs. 26.9% NRL vs. 18.4% GP). This ORL high dose corticosteroid penchant may be influenced by some ORL authors’ publications which use 100 mg or more as initial treatment por APFP advocating a relative reduction in nonrecovery facial nerve function.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Kasle et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> reported a 46.2% prescription of AVT for BP. Less than 13% of the participants in this survey routinely used AVT for BP but 30.9% did consider using it sometimes, mainly when pain or severe palsy (V-VI grades of House-Brackmann scale) are present at onset. Pursuant to CPGs oral AVT may be offered in addition to oral steroids within 72 h of symptom onset for patients with BP.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,5</span></a> It is important to bear in mind that RHS can present without the typical vesicular eruption in the pina (zoster sine herpete) in up to 30% of cases<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> so we should suspect it when facing a severe or painful case at onset in order to not misdiagnose it as BP.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> It is precisely in these cases were adding AVT to corticosteroid therapy has been shown to be more beneficial.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,13</span></a> A recent meta-analysis sustains the benefits of combined corticosteroids and AVT therapy for better facial function recovery and has underlined it as the only effetive treatment for synkinesis.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Surprisingly, the percentage of non-users of AVT for RHS was 11.4% in the present study. While BP recovers spontaneously in more than 70% of the cases, the possibilities of full recovery without treatment in RHS are approximately 20%.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The utilization of AVT in addition to corticosteroids in RHS has demonstrated to improve facial nerve function recovery rate and diminish sequelae.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Our results show a higher percentage of underdosage when using acyclovir, this may be influenced by the 5–6 times per day regimen of administration, compared to antivirals administrated 3 times per day such as valacyclovir or famciclovir or even 1 per day as brivudine. This must be considered because it is known that acyclovir has a 10–20% oral bioavailability or lower if it is taken with food. By contrast, famciclovir has an oral bioavailability as high as 60–75%, it is not affected by food intake, is highly selective for herpesvirus and has demonstrated better recovery rates than acyclovir in RSH.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Eye care</span><p id="par0145" class="elsevierStylePara elsevierViewall">Blink reduction, incomplete eye closure and decreased tear production secondary to a facial palsy may lead to dry eye and exposure keratopathy that can precipitate perforations and even endophthalmitis with significant long-term sequelae such as corneal leukomas and vision loss.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> Artificial tear drops, ophthalmic ointment and night ocular occlusion are usually enough to prevent these problems.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Even in Bell’s palsy, with a much higher recovery rate and better prognosis than Ramsay Hunt syndrome, early eye care must be a priority to avoid possible eye-related complications. All participants in this survey, along the lines of CPGs recommendations,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> agreed in advising eye care when facing an APFP.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Facial exercises</span><p id="par0150" class="elsevierStylePara elsevierViewall">During the stage of flaccid paralysis (up to three months in some cases) the facial nerve is healing and exercises such us chewing gum, puffing up balloons or mimicking in front of a mirror should be avoided. Most Bell’s palsies will recover completely spontaneously. Facial exercises without medical supervision are not useful and can even be counterproductive. They may promote aberrant reinnervation and excessive motor unit recruitment fostering anomalous movement patterns, synkinesis, mass action and hypertonicity when reinnervation occurs.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,19</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">There is a widespread misconception that facial exercises immediately after APFP onset may help facial nerve recovery. Information available on the internet is usually inconsistent. This issue is reflected in this survey, where 36.1% of ORL, 48.6% of NRL and 58.9% of GP recommend them routinely. Residents seem to be more aware of this and their prescription of chewing gum and puffing up balloons recommendation is lower than attendings’ for all three specialties (ORL: 24.2% vs. 37.7%, NRL: 32% vs. 50.8%, GP: 37.2% vs. 62.5%). It has been published that younger physicians are more prone to adhere to new CPGs,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> so we can expect more accurate recommendations regarding facial exercises in future years.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Learning influence</span><p id="par0160" class="elsevierStylePara elsevierViewall">In this study the two main sources on which clinical management of APFP were based were CPGs and residency, personal experience was the third one. Ansari et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> highlighted the influence of the knowledge transmitted by specialist to residents and personal experience in prescription habits.</p><p id="par0165" class="elsevierStylePara elsevierViewall">As mentioned before, there are differences in the management of APFP between GP, NRL and ORL. Assessed by groups, the results showed that even in the same specialty there were differences among their respondents not always being adjusted to CPG recommendations. A difficulty to change habitual clinical practice despite the publication of new CPGs has been documented.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> This reluctance to change could be explained by lack of awareness of these new publications, variance between CPGs from different societies and disagreement based on personal experience.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> It is therefore paramount to provide an updated training to our residents to avoid teaching them habits that could be hard to break afterwards.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Usually, CPGs are published in specific journals of each specialty and may not reach other concerning professional resulting in a specialty-based treatment. Taufique et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> highlighted the importance of spreading CPGs among all the specialties involved in the treatment of one pathology. This would reduce the variability in management of the condition assessed irrespective of the specialist who treats it resulting in better patient’s outcome.</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Side effects</span><p id="par0175" class="elsevierStylePara elsevierViewall">Corticosteroids for facial paralysis are well tolerated drugs and while they can have secondary effects, they are often minor and temporary.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Ansari et al.,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> in an online survey that analyzed corticosteroid prescription habits for different otorhinolaryngological conditions, reported 30% of side effects. This percentage differs from the 17% found in the present study but exact comparison could not be made because they considered not only facial paralysis but also acute rhinosinusitis, chronic rhinosinusitis with and without polyps and sudden sensorineural hearing loss with different dosage, duration and tapering for each one.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Deflazacort has been shown to have lower secondary effects than prednisone, having the first higher glucocorticoid and much less mineralocorticoid power than the later.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22,23</span></a> Glucocorticoid effect mimics cortisol and controls mainly carbohydrates metabolism and inflammatory response, while mineralocorticoid effect mimics aldosterone and is related to Na + and k + balance regulation.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> This could explain the fewer deflazacort reported side effects in the present study. In addition, the higher specialists side effects report is reasonable because patient’s follow up and accumulated clinical experience is higher in this subgroup compared to residents.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Limitations</p><p id="par0190" class="elsevierStylePara elsevierViewall">For convenience, corticosteroids dosage has been settled based on CPGs of both the American Academy of Neurology and the American Academy of Otolaryngology—Head and Neck Surgery Foundation<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4,6,7</span></a> and the recommendations of the facial paralysis CPG of the Spanish Society of Otorhinolaryngology.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The authors considered these CPG widely spread. If other CPGs would have been chosen, the percentage of correct under or overdose would have been different, but trying to point out if prescription was right or wrong was not the objective of this survey but the variability in prescription habits among specialties.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Due to members of each society participating in this survey can configurate their online profile in their respective web pages selecting specific issues on which they want to receive information and on which not, it was not possible to know how many of them finally received the survey and so the response rate could not be calculated. Nontheless, 1039 is a significant number of completed surveys that offers reliable results.</p></span></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Conclusion</span><p id="par0200" class="elsevierStylePara elsevierViewall">There is a general agreement in the use of corticosteroids and recommending eye care as part of the treatment of APFP, but there is a big variability in the dosage of corticosteroids among specialties.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Despite the proved efficacy of AVT in RHS there are still physicians that do not use it</p><p id="par0210" class="elsevierStylePara elsevierViewall">There is a high percentage of facial exercises recommendation as part of the treatment of APFP.</p><p id="par0215" class="elsevierStylePara elsevierViewall">Transmission of an updated knowledge to residents is crucial if better outcome for patients is wanted.</p><p id="par0220" class="elsevierStylePara elsevierViewall">Corticosteroids and AVT for APFP have a low rate of reported side effects.</p></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Authors contributions</span><p id="par0225" class="elsevierStylePara elsevierViewall">All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by José Manuel Morales-Puebla, and Luis Lassaletta. The first draft of the manuscript was written by José Manuel Morales Puebla and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Disclosure statement</span><p id="par0230" class="elsevierStylePara elsevierViewall">The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.</p><p id="par0235" class="elsevierStylePara elsevierViewall">This research has not received specific support from public, commercial or non-profit entities.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres2075187" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1770780" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2075188" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1770781" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 5 => array:2 [ "identificador" => "sec0001" "titulo" => "Objective" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Clinical practice survey" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Target physicians" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Pharmacotherapy: possible treatment regimes" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical methods" ] ] ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Specialty, age and sex" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Corticosteroids for APFP" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Antiviral therapy" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Eye care" ] 4 => array:2 [ "identificador" => "sec0060" "titulo" => "Facial exercises" ] 5 => array:2 [ "identificador" => "sec0065" "titulo" => "Learning influence" ] 6 => array:2 [ "identificador" => "sec0070" "titulo" => "Side effects" ] ] ] 8 => array:3 [ "identificador" => "sec0075" "titulo" => "Discussion" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Medical treatment for APFP" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "Eye care" ] 2 => array:2 [ "identificador" => "sec0090" "titulo" => "Facial exercises" ] 3 => array:2 [ "identificador" => "sec0095" "titulo" => "Learning influence" ] 4 => array:2 [ "identificador" => "sec0100" "titulo" => "Side effects" ] ] ] 9 => array:2 [ "identificador" => "sec0105" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0110" "titulo" => "Authors contributions" ] 11 => array:2 [ "identificador" => "sec0115" "titulo" => "Disclosure statement" ] 12 => array:2 [ "identificador" => "xack722934" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-03-21" "fechaAceptado" => "2023-05-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1770780" "palabras" => array:5 [ 0 => "Facial paralysis" 1 => "Corticosteroid therapy" 2 => "Antiviral therapy" 3 => "Eye care" 4 => "Facial nerve rehabilitation" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1770781" "palabras" => array:5 [ 0 => "Parálisis facial" 1 => "Corticosteroides" 2 => "Antivirales" 3 => "Cuidados del ojo" 4 => "Rehabilitación de parálisis facial" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Acute peripheral facial paralysis may be diagnosed and treated by different specialists.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to explore the variability in the treatment of Bell’s palsy (BP) and Ramsay Hunt Syndrome (RHS) among different medical specialties.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An anonymous nationwide online survey was distributed among the Spanish Societies of Otorhinolaryngology (ORL), Neurology (NRL) and Family and Community Medicine (GP).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">1039 responses were obtained. 98% agreed on using corticosteroids, ORL using higher doses than NRL and GP. Among all, only 13% prescribed antivirals in BP routinely, while 31% prescribed them occasionally. The percentage of specialists not using antivirals for RHS was 5% of ORL, 11% of NRL, and 23% of GP (GP vs. NRL p = 0.001; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0,002). 99% recommended eye care. Exercises as chewing gum or blowing balloons were prescribed by 45% of the participants with statistically significant differences among the three specialties (GP vs. NRL p = 0.021; GP vs. ORL p < 0.0001; NRL vs. ORL p = 0.002).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">There is general agreement in the use of corticosteroids and recommending eye care as part of the treatment of acute peripheral facial paralysis. Yet, there are discrepancies in corticosteroids dosage, use of antivirals and recommendation of facial exercises among specialties.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La parálisis facial periférica aguda puede ser diagnosticada y tratada por diferentes especialistas.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es analizar la variabilidad entre especialidades en el tratamiento de la parálisis de Bell (PB) y del síndrome de Ramsay-Hunt (SRH).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Métodos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se distribuyó una encuesta anónima online entre los miembros de la Sociedad Española de Otorrinolaringología (ORL), la Sociedad Española de Neurología (NRL) y la Sociedad de Medicina Familiar y Comunitaria (MF).</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Se recopilaron 1039 respuestas. El 98% de los participantes coincidieron en el uso de corticoides, los ORL utilizaron dosis más altas que NRL y MF. Del total de encuestados, el 13% recomendaba antivirales en la PB de manera rutinaria, mientras que el 31% los recomendaba en ocasiones. El 5% de ORL, 11% de NRL, y 23% de MF (MF vs. NRL p = 0.001; MF vs. ORL p < 0.0001; NRL vs. ORL p = 0,002) no utilizaba antivirales en el tratamiento del SRH. El 99% de añadía cuidados del ojo al tratamiento de la parálisis facial. El 45% de los participantes aconsejaba ejercicios faciales como mascar chicle o inflar globos con diferencias estadísticamente significativas entre las tres especialidades (MF vs. NRL p = 0.021; MF vs. ORL p < 0.0001; NRL vs. ORL p = 0.002).</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Existe acuerdo general en la utilización de corticoides y recomendar cuidados del ojo como parte del tratamiento de la parálisis facial periférica. A pesar de ello, existen diferencias en las dosis utilizadas, la utilización de antivirales o la recomendación de ejercicios faciales entre especialidades.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0250" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0125" ] ] ] ] "multimedia" => array:8 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1341 "Ancho" => 2513 "Tamanyo" => 144756 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Costicosteroid dosage. Percentage of correct (black), under (light grey) and overdosing (dark grey) is shown in each specialty. GP: general practitioners; NRL: neurologists; ORL: otorhinolaryngologists.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1341 "Ancho" => 2513 "Tamanyo" => 126405 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Antiviral therapy use in Bell’s palsy by specialty. Percentage of use (black), non use (light grey) and sometimes use (dark grey) is shown in each specialty. AVT: antiviral therapy; BP: Bell’s palsy; GP: general practitioners; NRL: neurologists; ORL: otorhinolaryngologists.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1342 "Ancho" => 2513 "Tamanyo" => 109910 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Antiviral therapy use in Ramsay Hunt syndrome. The percentage of use (black) and non use (grey) is shown in each specialty. AVT: antiviral therapy; RHS: Ramsay Hunt syndrome; GP: general practitioners; NRL: neurologists; ORL: otorhinolaryngologists.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1322 "Ancho" => 2513 "Tamanyo" => 143773 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Antiviral therapy dosage. Percentage of correct (black), under (light grey) and overdosing (dark grey) is shown in each specialty. GP: general practitioners; NRL: neurologists; ORL: otorhinolaryngologists.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">ORL: otorhinolaryngologist, NRL: neurologist, GP: general practitioner.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Online survey questions</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. Which is your specialty? (Choose one) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ ORL specialist \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ ORL resident \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ NRL specialist \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ NRL resident \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ GP specialist \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ GP resident \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Other \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. Do you use steroids to treat peripheral facial paralysis? (Choose one) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. If yes, specify drug, dosage, and treatment regimen. (Open-set question) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. Do you use antiviral therapy to treat Bell’s palsy? (Choose one) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Sometimes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5. Do you use antiviral therapy to treat Ramsay-Hunt syndrome? (Choose one) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6. If you use antiviral therapy (questions 4 and 5), specify when, drug, dosage, and treatment regimen. (Open set question) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7. Do you recommend eye care as part of facial paralysis treatment? (Choose one) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8. Do you recommend chewing gum and puffing up balloons as part of your facial paralysis treatment? (Choose one) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9. Treatment used is based on: (More than one can be chosen) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Residency \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Personal experience \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Clinical practice guidelines \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Scientific papers \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Internet general information \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">□ Others (specify) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10. Have you observed side effects with the treatment used? (Open set answer) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3436618.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Online survey questions.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Steroid dosage \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral prednisolone 50 mg for 10 days<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral prednisone 60 mg for 5 days with a 10 mg-day tapper<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral prednisone mg/kg/day for 5 days with a 10 mg-day tapper<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3436620.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antiviral dosage<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral acyclovir 800 mg every 4 h (night dosage can be skipped) for 7−10 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral valacyclovir 1 g every 8 h for 7 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral famcyclovir 500 mg every 8 h for 7 days \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral brivudine 125 mg every 24 h for 7 days \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3436621.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Steroid and antiviral therapy dosage recommended based on the main clinical guidelines.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ORL: otorhinolaryngologist, NRL: neurologist, GP: general practitioner.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n = 1039 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Specialist \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Residents \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Specialist vs residents \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ORL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">451 (43.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62 (6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">513 (49.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.9%/12.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NRL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">197 (19%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 (2.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">222 (21.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.7%/11.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">261 (25.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (4.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">304 (29.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.5%/12.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">909 (87.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">130 (12.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1039 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.5%/12.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3436619.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Global distribution by specialty. The global percentage of participation by specialty and expertise (specialist or resident) is shown. The last column represents the percentage of specialist and residents in each specialty subgroup.</p>" ] ] 7 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 95971 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guideline: Bell’s palsy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.F. Baugh" 1 => "G.J. Basura" 2 => "L.E. Ishii" 3 => "S.R. Schwartz" 4 => "C.M. Drumheller" 5 => "R. Burkholder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0194599813505967" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2013" "volumen" => "149" "paginaInicial" => "S1" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24189771" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Combination therapy is preferable for patients with Ramsay Hunt syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.A. de Ru" 1 => "P.P. van Benthem" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MAO.0b013e31821a00e5" "Revista" => array:6 [ "tituloSerie" => "Otol Neurotol" "fecha" => "2011" "volumen" => "32" "paginaInicial" => "852" "paginaFinal" => "855" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21593701" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of Bell palsy: clinical practice guideline" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.R. de Almeida" 1 => "G.H. 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Paduga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/WNL.0b013e318275978c" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2012" "volumen" => "79" "paginaInicial" => "2209" "paginaFinal" => "2213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23136264" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Facial paralysis: clinical practice guideline of the Spanish Society of Otolaryngology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Lassaletta" 1 => "J.M. Morales-Puebla" 2 => "X. Altuna" 3 => "Á Arbizu" 4 => "M. Arístegui" 5 => "Á Batuecas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otorri.2018.12.004" "Revista" => array:5 [ "tituloSerie" => "Acta Otorrinolaringol Esp (Engl Ed)" "fecha" => "2020" "volumen" => "71" "paginaInicial" => "99" "paginaFinal" => "118" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconciling the clinical practice guidelines on Bell’s palsy from the AAO-HNSF and the AAN" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.R. Schwartz" 1 => "S.L. Jones" 2 => "T.S. Getchius" 3 => "G.S. Gronseth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0194599814529079" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Head Neck Surg" "fecha" => "2014" "volumen" => "150" "paginaInicial" => "709" "paginaFinal" => "711" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24789656" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reconciling the clinical practice guidelines on Bell’s palsy from the AAO-HNSF and the AAN" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.R. Schwartz" 1 => "S.L. Jones" 2 => "T.S. Getchius" 3 => "G.S. Gronseth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1212/wnl.0000000000000463" "Revista" => array:6 [ "tituloSerie" => "Neurology" "fecha" => "2014" "volumen" => "82" "paginaInicial" => "1927" "paginaFinal" => "1929" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24793182" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variations in the management of acute Bell’s palsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D.A. Kasle" 1 => "S.J. Torabi" 2 => "E. Savoca" 3 => "J.I. Tower" 4 => "D. Hildrew" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjoto.2019.102299" "Revista" => array:3 [ "tituloSerie" => "Am J Otolaryngol" "fecha" => "2020" "volumen" => "41" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "Medicine Online Information Center of AEMPS — CIMA" "fecha" => "2017" "editorial" => "Spanish Agency of Medicines and Medical Devices" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adherence to Subspecialty guidelines in the emergency department" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Z. Taufique" 1 => "M. Timen" 2 => "J.L. Swartz" 3 => "D.R. 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Original article
Variations in the treatment of acute peripheral facial paralysis. A nationwide survey
Encuesta nacional sobre la variabilidad en el tratamiento de la parálisis facial periférica aguda
José Manuel Morales-Pueblaa,b,c,d,
, Mireya Fernández-Fourniere,f, Antoni Plana-Blancog,h,i, Luis Lassalettaa,b,c,d
Autor para correspondencia
a Department of Otolaryngology, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain
b Otology Commission of the Spanish Society of Otolaryngology and Head and Neck Surgery, Spain
c Biomedical Research Networking Centre on Rare Diseases (CIBERER), Institute of Health Carlos III, U761, Madrid, Spain
d Autonomous University of Madrid, School of Medicine, Madrid, Spain
e Neurology Department, La Paz University Hospital, IdiPaz, Paseo de La Castellana 261, 28046, Madrid, Spain
f Neuroepidemiology Coordinator of the Spanish Society of Neurology, Spain
g Primary Care Center of Balàfia-Pardinyes-Secà de St. Pere, Lleida, Spain
h Neurology Coordinator of the Spanish Society of Family and Community Medicine, Spain
i University of Lleida, School of Medicine, Lleida, Spain
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