Decompression for Bell's palsy: why I don't do it.

All decompression surgery is based on the lack of understanding that Bell's palsy is a viral demyelinating disease that is longitudinal--not perpendicular--to the facial canal and that surgery cannot possibly help a viral disease. These findings exclude the etiologic possibility of an "ischemic paralysis" and are in accord with our logically derived belief that treatment directed to relieve neural entrapment is a wasted effort.

A preliminary study of cocaine absorption from the nasal mucosa.

Objective/hypothesis: To determine factors affecting the safe use of topical cocaine for anesthesia and vasoconstriction during rhinologic surgery.

Study Design: Prospective, randomized study of the kinetics of cocaine absorption through human nasal mucosa in 12 consecutive patients without nasal mucosal disease who were having septoplasty or septorhinoplasty.

Methods: With patients under general anesthesia, cocaine was applied topically to each nasal cavity by using cottonoid pledgets.

Bell's palsy treatment with acyclovir and prednisone compared with prednisone alone: a double-blind, randomized, controlled trial.

In a double-blind study, we compared the final outcome of 99 Bell's palsy patients treated with either acyclovir-prednisone (53 patients) or placebo-prednisone (46 patients). For patients receiving acyclovir, the dosage was 2,000 mg (400 mg 5 times daily) for 10 days. Electrical tests included electroneurography and the maximal stimulation test.

An analysis of the Adour-Swanson and House-Brackmann grading systems for facial nerve recovery.

Lack of uniformity in reporting facial nerve recovery in patients with facial nerve paralysis has been a major disadvantage in comparing treatment modalities. To remove subjectivity from the analysis, we devised a facial paralysis recovery profile as a system for measuring facial motion. This profile has been used since 1968 at Kaiser Permanente Medical Center, Oakland, California.