Patient-Reported Outcomes in Facial Paralysis: An Analysis Across Etiologies

Introduction: Facial paralysis significantly impacts patient function and well-being but less is known about variations in patient-reported function and appearance outcomes across different etiologies.

Methods: This cross-sectional, single-center study used the FACE-Q Paralysis scales to assess outcomes across Bell's palsy, acoustic neuroma, tumor resection, Ramsay Hunt syndrome, and facial nerve schwannoma. Spearman’s correlations, Kruskal-Wallis tests, chi-square tests, and regression models examined the influence of paralysis duration, prior surgical interventions, emotional intelligence score, and paralysis severity (Sunnybrook score). Statistical significance was defined as a p-value < 0.05 for all analyses.

Results: The study included 121 patients with facial paralysis: Bell's palsy (n=51), acoustic neuroma (n=30), tumor resection (n=21), Ramsay Hunt syndrome (n=9), and facial nerve schwannoma (n=10). Emotional intelligence strongly predicted psychological (β=10.33, SE=1.39, p< 0.001) and social function (β=9.74, SE=1.37, p < 0.001) across all etiologies. In Bell's palsy, longer duration correlated with improved speech (r=0.37, p< 0.01) but decreased social function (r= -0.29, p=0.02), while prior procedures improved psychological (β=12.5, 95% CI: 2.97–21.5) and social outcomes (β=9.76, 95% CI: 1.46–19.06). After controlling for duration and severity, tumor resection was associated with poorer outcomes across speech, eating/drinking, eye function, facial movement, and social domains (all p< 0.05).

Conclusions: Emotional well-being was the strongest predictor of psychosocial outcomes, regardless of etiology. In Bell's palsy, longer duration correlated to improved speech but decreased social function, highlighting psychosocial adaptation during recovery. Tumor resection was associated with significantly poorer functional and social outcomes, emphasizing the unique challenges posed by different etiologies. These findings support addressing etiology-specific needs in facial paralysis.