Impact of the COVID-19 Pandemic on Emergency Department Visits for Idiopathic Facial Nerve Palsy: An Interrupted Time-Series Analysis

From Top Italian Scientists Journal
Published
January 10, 2025
Title
Impact of the COVID-19 Pandemic on Emergency Department Visits for Idiopathic Facial Nerve Palsy: An Interrupted Time-Series Analysis
Authors
Francesco Brigo, Gianni Turcato, Serena Sibilio, Arian Zaboli.
DOI
10.62684/XYYW4586
Keywords
Bell’s palsy; COVID-19 pandemic; Emergency Department; Epidemiology; Idiopathic facial nerve palsy; SARS-Cov-2.
Downloads
Download PDF
Download PDF

Francesco Brigo(a), Gianni Turcato(b), Serena Sibilio(c), Arian Zaboli(a)

(a) Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.

(b) Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy.

(c) Institute of Nursing Science, University of Basel-Department of Public Health, Basel, Switzerland

Correspondence to: Francesco Brigo, francesco.brigo@sabes.it

Abstract

This study evaluated the impact of the COVID-19 pandemic and related social restrictions on emergency department (ED) visits for idiopathic facial nerve palsy (IFNP). A retrospective observational analysis was conducted on a consecutive cohort of patients presenting to a hospital ED from January 1, 2015, to December 31, 2021. Monthly ED visit rates for IFNP were compared before and after the onset of the pandemic and the national lockdown in March 2020 using interrupted time-series analysis. Data were standardized to 1,000 ED visits per month. Among 248,606 total ED visits during the study period, 266 (0.11%) were due to IFNP. No significant change in standardized ED visits for IFNP was observed immediately following the pandemic’s onset (1.08/1,000 visits; 95% CI: -0.06 to 2.23; p=0.063). However, a significant reduction in visit rates was noted in the months following March 2020 (-0.08/1,000 visits; 95% CI: -0.15 to -0.002; p=0.043). The decline in IFNP ED visits likely reflects the protective effects of social distancing measures, face mask usage, and reduced viral transmission during the pandemic. These findings challenge claims of increased IFNP risk associated with SARS-CoV-2 infection or vaccination. Furthermore, the results support the hypothesis that neurotropic viruses contribute to the pathogenesis of IFNP and highlight the role of public health measures in reducing disease incidence. This study provides novel insights into the indirect benefits of pandemic-related interventions on viral-associated conditions such as IFNP.

Declarations

Conflict of interest

The Authors declare that there is no conflict of interest.

Funding

The authors have no funding sources to report.

Author Contributions

Francesco Brigo: Conceptualization, Methodology, Investigation, Supervision, Data curation, Writing-Original draft preparation; Serena Sibilio: Investigation; Gianni Turcato: Investigation; Arian Zaboli: Conceptualization, Methodology, Investigation, Formal analysis, Data curation, Writing-Original draft preparation

References

  1. Hauser WA, Karnes WE, Annis J, Kurland LT (1971) Incidence and prognosis of Bell's palsy in the population of Rochester, Minnesota. Mayo Clin Proc 46:258-264
  2. Morris AM, Deeks SL, Hill MD, Midroni G, Goldstein WC, Mazzulli T, Davidson R, Squires SG, Marrie T, McGeer A, Low DE (2002) Annualized incidence and spectrum of illness from an outbreak investigation of Bell's palsy. Neuroepidemiology 21(5):255-61. DOI: 10.1159/000065645
  3. Adour KK, Bell DN, Hilsinger RL Jr (1975) Herpes simplex virus in idiopathic facial paralysis (Bell palsy). JAMA. 233(6):527-30.
  4. Murakami S, Mizobuchi M, Nakashiro Y, Doi T, Hato N, Yanagihara N (1996) Bell palsy and herpes simplex virus: identification of viral DNA in endoneurial fluid and muscle. Ann Intern Med. 124(1 Pt 1):27-30. DOI: 10.7326/0003-4819-124-1_part_1-199601010-00005
  5. Schirm J, Mulkens PS (1997) Bell's palsy and herpes simplex virus. APMIS. 105(11):815-23. DOI: 10.1111/j.1699-0463.1997.tb05089.x
  6. Kennedy PG (2010) Herpes simplex virus type 1 and Bell's palsy-a current assessment of the controversy. J Neurovirol. 16(1):1-5. DOI: 10.3109/13550280903552446
  7. Morgan M, Nathwani D (1992) Facial palsy and infection: the unfolding story. Clin Infect Dis. 14(1):263-71. DOI: 10.1093/clinids/14.1.263
  8. Peitersen E (2002) Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl. 549:4-30.
  9. Monini S, Lazzarino AI, Iacolucci C, Buffoni A, Barbara M (2010) Epidemiology of Bell's palsy in an Italian Health District: incidence and case-control study. Acta Otorhinolaryngol Ital. 30(4):198.
  10. Corey L, Spear PG (1986) Infections with herpes simplex viruses (1). N Engl J Med. 314(11):686-91.
  11. Zaboli A, Brigo F, Sibilio S, Fanni Canelles M, Rella E, Magnarelli G, Pfeifer N, Turcato G (2022) The impact of COVID-19 pandemic on the urgency of patients admitted to the emergency department. Int Emerg Nurs. 65:101229. DOI: 10.1016/j.ienj.2022.101229
  12. Gupta S, Jawanda MK, Taneja N, Taneja T (2021) A systematic review of Bell's Palsy as the only major neurological manifestation in COVID-19 patients. J Clin Neurosci. 90:284-292. DOI: 10.1016/j.jocn.2021.06.016
  13. Lai YH, Chen HY, Chiu HH, Kang YN, Wong SB (2022) Peripheral Nervous System Adverse Events after the Administration of mRNA Vaccines: A Systematic Review and Meta-Analysis of Large-Scale Studies. Vaccines (Basel). 10(12):2174. DOI: 10.3390/vaccines10122174
  14. Gordon AJ, Varelas A, Eytan DF (2023) Bell's Palsy After Vaccination Against Covid-19: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg. doi: 10.1002/ohn.385.
  15. Soltanzadi A, Mirmosayyeb O, Momeni Moghaddam A, Ghoshouni H, Ghajarzadeh M (2023) Incidence of Bell's palsy after coronavirus disease (COVID-19) vaccination: a systematic review and meta-analysis. Neurologia (Engl Ed). 9:S2173-5808(23)00038-X. DOI: 10.1016/j.nrleng.2023.06.002
  16. Rafati A, Pasebani Y, Jameie M, Yang Y, Jameie M, Ilkhani S, Amanollahi M, Sakhaei D, Rahimlou M, Kheradmand A (2023) Association of SARS-CoV-2 Vaccination or Infection With Bell Palsy: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 149(6):493-504. DOI: 10.1001/jamaoto.2023.0160
  17. Bernal JL, Cummins S, Gasparrini (2017). Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol. 46:348-355. DOI: 10.1093/ije/dyw098
  18. Turcato G, Zaboli A, Luchetti A, Sighele F, Sibilio S, Donato C, et al (2022) "Effect of the SARS-COV-2 pandemic outbreak on the emergency department admission for an acute psychiatric condition". J Psychiatr Res. 151:626-632. DOI: 10.1016/j.jpsychires.2022.05.035
  19. Brigo F, Zaboli A, Rella E, Sibilio S, Canelles MF, Magnarelli G, et al (2022) The impact of COVID-19 pandemic on temporal trends of workplace violence against healthcare workers in the emergency department. Health Policy. 126:1110-1116. DOI: 10.1016/j.healthpol.2022.09.010