| OBJECTIVE: Bell’s palsy(BP)is defined as idiopathic peripheral facial paralysis.Most patients achieve complete recovery of facial nerve function,but some patients may still have residual paralysis or hemifacial spasm even after drug treatment.In the early stage of Bell’s palsy,facial nerves undergo edema,demyelination,degeneration,etc.Clinically,electrophysiological examinations are used to detect the conduction function of facial nerves,thereby predicting the recovery of facial nerve function,which provides information for clinical decision-making to prevent adverse outcomes as much as possible.This study explored the diagnostic value of electroneurography(ENoG)by meta-analysis for predicting complete recovery of facial nerve function in patients with Bell’s palsy.METHODS: Databases including PubMed,Cochrane,and Embase were searched to evaluate the prognosis of Bell’s palsy with ENoG.The search time began from database to December 2018.Meta-analysis was performed using statistical software revman 5.3 and Meta-disc 1.4,and each effect index was expressed by 95% confidence interval(CI).The degeneration index(DI)of the lateral ENoG before treatment and the complete recovery of the facial nerve function were analyzed.According to the heterogeneity test results,either the random effects model or the fixed effect model was used to complete the analysis,and the predictive value of ENoG for complete recovery of the facial nerve function of Bell’s palsy was evaluated.RESULTS: 7 studies were included in the meta-analysis after searching strategies.Since the sensitivity of a study included is 100% and the specificity is 0%,the calculation of the combined effect index didn’t absorb it.One of the studies has documented ENOG in two different periods,so it was taken as two studies the extracted data for analysis.Sensitivity(SEN),specificity(SPE),diagnostic odds ratio(DOR),positive likelihood ratio(PLR),negative likelihood ratio(NLR),calculation of the area under the SROC curve(AUC),and subgroups analysis were performed to investigate diagnostic efficacy of ENoG in predicting the complete recovery of Bell’s palsy.The results showed that there was no threshold effect in the study of the combined effect size;the combined sensitivity of all included studies was 0.90(95% CI: 0.86-0.94),the combined specificity was 0.56(95% CI: 0.46-0.66),and the combined diagnostic odds ratio was 10.69(95% CI: 4.95-23.07),the combined positive likelihood ratio was 1.75(95% CI: 1.38-2.22),and the combined negative likelihood ratio was 0.21(95% CI: 0.13-0.35).The area under the curve of SROC was 0.8334.Subgroup analysis was performed.The combined DOR,SEN,SPE,and areas under the SROC curves for subgroups were: prospective study group: 14.091(95% CI: 5.351-37.108),0.937(95% CI: 0.887-0.9691),0.500(95%).CI: 0.355-0.645),0.8589,retrospective study group: 8(95% CI: 2.15-29.81),0.83(95% CI: 0.72-0.91),0.62(95% CI: 0.47-0.75),0.8034 respectively.It suggested that the area under the two sets of curves were above 0.8.The DOR,SEN,and AUC were higher in the prospective study design group than in the retrospective study group.The nasolabial fold measurement group: 12.825(95% CI: 4.988-32.973),0.933(95% CI: 0.881-0.968),0.500(95% CI: 0.325-0.684),0.8506,orbicularis oculi measurement group: 4.704(95% CI: 1.737-12.738),0.804(95 %CI: 0.669-0.902),0.568(95% CI: 0.410-0.717),AUC cannot be calculated.It showed that the combined DOR and SEN of the nasolabial fold measurement group were significantly higher than the orbicularis oculi measurement group,and higher than DOR and AUC values of all studies pooled.Group within 7 days: 7.162(95%CI:2.349-21.841)、0.890(95%CI:0.812-0.944)、0.536(95%CI:0.397-0.670),group 7-14 days measurement: 26.800(95% CI: 7.871-91.244),0.935(95% CI: 0.863-0.976),0.633(95% CI: 0.439-0.801)),the AUC value of this subgroups in the Meta-Disc software couldn’t be calculated because of the limited studies in the subgroup.The combined effect such as DOR,SEN,and SPE in the 7-14 days group was higher than the other subgroups,and higher than the combined effect of all the included studies pooled.CONCLUSION: ENoG reflects the conduction functional status of facial nerves as a quick,convenient,objective and sensitive means.In the acute stage,the detection is effective in judging the prognosis of Bell’s palsy,and the detection of ENOG in the nasolabial fold is better in sensitivity,specificity and diagnostic odds ratio than in the orbicularis oculi,and the diagnostic efficiency of ENOG in diagnosing the prognosis of complete recovery of Bell’s palsy maybe higher when completed during 7-14 days. |
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