International Journal of Pediatric Otorhinolaryngology
The neutrophil to lymphocyte ratios of our pediatric patients with Bell's palsy
Introduction
Neutrophil to lymphocyte ratio (NLR) is considered to be a reliable indicator in etiological investigation and identification of the disease severity in inflammatory disorders [1], [2], [3], [4], [5], [6], [7], [8], [9]. NLR, an easy and inexpensive parameter which can be calculated by using the complete blood count, has been investigated in many inflammatory disorders [1], [2], [3], [4]. There are studies showing that NLR is a valuable indicator in disorders such as sudden hearing loss, vestibular neuronitis, rheumatoid arthritis, cystic fibrosis, premature retinopathy and Bell's palsy, in which the inflammatory processes are considered to participate in the etiology [1], [2], [3], [4], [5], [6], [7], [8], [9].
Bell's palsy is the most common cause of facial paralysis in both adults and children [10], [11]. There are numerous observations or evidences suggesting that Bell's palsy is an inflammatory disorder of the facial nerve [12], [13], [14], [15], [16], [17], [18]. Firstly, patients appear to benefit from corticosteroid therapy [13]. Murakami et al., in their study, detected the Herpes simplex type 1 genome in endoneurial fluids and posterior auricular muscles of patients with Bell's palsy [14]. Herpes simplex is considered to cause an inflammation which results in acute, benign cranial neuropathy [15], [16]. In magnetic resonance imaging of patients with Bell's palsy, increased involvement of the facial nerve was found, showing inflammation [17]. Additionally, the inflammation of the nerve was revealed when facial nerve decompression was performed in patients with Bell's palsy [18]. It is considered that inflammation of the facial nerve is related either to a new virus or to the reactivation of a virus present in the body [19]. Another evidence supporting inflammatory etiology is the high NLR found in adult patients with Bell's palsy [5], [6], [7]. In these studies, the compliance between elevation of NLR and disease severity was investigated [5], [6], [7]. In this study, our aim was to investigate the presence of any clue which might suggest inflammatory etiology and also the presence of compliance between NLR elevation and inflammation severity in children as determined in the adult group.
Section snippets
Material and method
Patients who were younger than 18 years and diagnosed with Bell's palsy between January 2013 and April 2015 in outpatient clinics of Otorhinolaryngology and Pediatric Neurology in Adnan Menderes University Medical Faculty, were retrospectively investigated. Patients who had another inflammatory disorder in addition to Bell's palsy were excluded from the study. A total of 25 patients were found who met this criterion. 25 healthy individuals who were admitted to outpatient clinics of Pediatrics
Statistical analysis
Kolmogorov–Smirnov test was used to determine whether quantitative variables were distributed normally or not. In terms of normally distributed quantitative variables, groups were compared by independent samples t-test and descriptive statistics were given as mean ± standard deviation.
In terms of variables not having normal distribution, groups were compared using the Mann–Whitney U test and the descriptive statistics were given as median (25–75 percentile). The chi-square analysis was used for
Results
The mean age was 9.86 ± 5.07 in the patient group and 9.14 ± 5.94 in the control group. Male: female ratio was 10:15 in the patient group and 11:14 in the control group. The age and gender data of the patient and control groups were compatible. Pre-treatment House–Brackmann classification revealed grade 2 in 6 patients, grade 3 in 2 patients, grade 4 in 12 patients and grade 5 in 5 patients. In all members of the patient group, oral prednisolone (1 mg/kg/d) was administered for 7 days and then it
Discussion
NLR, which is an easily available and inexpensive parameter, is a novel marker which has recently started to be used in inflammatory disorders. It is considered to indicate inflammatory pathology and also to provide valuable information about prognosis [1], [2], [3], [4], [5], [6], [7], [8], [9]. Neutrophils are important for cytokine production in inflammatory disorders [21]. Lymphopenia is related to early apoptotic properties of lymphocytes during inflammation [22]. Neutrophil to lymphocyte
Conclusion
To our knowledge, NLR was studied for the first time in pediatric patients with Bell's palsy. High NLR values determined in pediatric patients with Bell's palsy support the inflammatory feature of this disease. NLR is recommended as a supportive parameter in the diagnosis of pediatric patients with Bell's palsy.
Conflict of interest
The authors report no conflicts of interest.
References (22)
- et al.
Predictive value of the neutrophil-to-lymphocyte ratio in patients with deep neck space infection secondary to acute bacterial tonsillitis
Int. J. Pediatr. Otorhinolaryngol.
(2015) - et al.
Outcome of peripheral facial palsy in children – a catamnestic study
Eur. J. Paediatr. Neurol.
(2013) - et al.
Scales of degree of facial paralysis: analysis of agreement
Braz. J. Otorhinolaryngol.
(2015) - et al.
Two new inflammatory markers associated with Disease Activity Score-28 in patients with rheumatoid arthritis: neutrophil–lymphocyte ratio and platelet–lymphocyte ratio
Int. J. Rheum. Dis.
(2015) - et al.
Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: novel markers for diagnosis and prognosis in patients with idiopathic sudden sensorineural hearing loss
Dis. Markers
(2014) - et al.
The blood neutrophil to lymphocyte ratio correlates with clinical status in children with cysticfibrosis: a retrospective study
PLOS ONE
(2013) - et al.
Serum neutrophil-to-lymphocyte ratio in retinopathy of prematurity
J. AAPOS
(2015) - et al.
New predictive parameters of Bell's palsy: neutrophil to lymphocyte ratio and platelet to lymphocyte ratio
Balk. Med. J.
(2015) - et al.
Elevated neutrophil-to-lymphocyte ratio in Bell's palsy and its correlation with facial nerve enhancement on MRI
Otolaryngol. Head Neck Surg.
(2015) - et al.
Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy
Laryngoscope
(2014)
The significance of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in vestibular neuritis
Laryngoscope
Cited by (28)
Predictive values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other prognostic factors in pediatric vestibular neuritis patients
2023, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :According to many recent studies, although it is difficult to determine the current clear cause of VN, the prevailing hypothesis is that a vestibular nerve or labyrinth may be infected by a virus and result in vestibular dysfunction [5,6]. Recent studies have shown that the Neutrophil to lymphocytes ratio (NLR) and platelet to lymphocyte ratio (PLR) can be used as a very simple and economical diagnostic tool to diagnose and identify inflammatory diseases [7,8]. In particular, higher levels of NLR, PLR results have been identified in current patients with Bell's palsy and Idiopathic sensorineural hearing loss [9].
Prognostic role of neutrophil lymphocyte ratio and mean platelet volume in Bell's palsy: Comparison of diabetic and non-diabetic patients
2023, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :Kılıçkaya et al.18 and Kum et al.14 showed a positive correlation between HBS and NLR: The NLR increased with the HB stage before treatment, similar to the results of our study. Atan et al.13 reported no statistically significant relationship between the NLR and pre-treatment HB score in adult patients and Eryılmaz et al.15 reported similar results in pediatric patients. The NLR was found to be significantly higher in nonDM-BP and DM-BP patients than in the control group in the present study.
Mean platelet volume, neutrophil- and platelet to lymphocyte ratios are elevated in vestibular neuritis
2019, Journal of Clinical NeuroscienceCitation Excerpt :In another study on idiopathic facial nerve paralysis, called Bell’s palsy, Dizdar et al. [32] reported that higher NLR is associated with the grade of the paralysis, and has positive correlation with the prognosis of the paralysis [32]. Eryilmaz et al. found similar results in the pediatric group of patients having Bell’s palsy [36]. Like ISNHL and Bell’s palsy, VN is described as an idiopathic disease, however the role of inflammation has been widely affirmed in its pathogenesis.
Elevated neutrophil to lymphocyte ratio in non-affective psychotic adolescent inpatients: Evidence for early association between inflammation and psychosis
2018, Psychiatry ResearchCitation Excerpt :Specifically, the NLR has been found to be elevated in specific inflammatory-related conditions in children. These include infection-related conditions (Bekdas et al., 2014; Eryilmaz et al., 2015; Han et al., 2016; Kelly et al., 2015; Mentis et al., 2016), autoimmune conditions (Dogru et al., 2016; Dogru and Yesiltepe Mutlu, 2016; Duksal et al., 2015; Gao et al., 2015; Güneş et al., 2015; Ha et al., 2015), and metabolic syndrome-related conditions (Aydın et al., 2015; Prats-Puig et al., 2015). The growing interest of inflammation role in psychiatric disorders and the availability of blood counts in clinical populations, have resulted in few studies showing increased NLR in psychiatric patients, mostly in patients with affective symptoms (Atli et al., 2015; Aydin Sunbul et al., 2016; Çakır et al., 2015; Demircan et al., 2016; Kalelioglu et al., 2015), but also with psychosis (Kulaksizoglu and Kulaksizoglu, 2016; Semiz et al., 2014).
Neutrophil to lymphocyte ratio in Bell's palsy
2016, International Journal of Pediatric Otorhinolaryngology