Recovery from Bell’s palsy after treatment using uncultured umbilical cord-derived mesenchymal stem cells:A case report

BACKGROUND Bell’s palsy is an idiopathic facial palsy with an unknown cause,and 75%of patients heal spontaneously.However,the other 25%of patients continue experiencing mild or severe disabilities,resulting in a reduced quality of life.Currently,various treatment methods have been developed to treat this disease.However,there is controversy regarding their effectiveness,and new alternative treatments are needed.CASE SUMMARY The patient suffered from left-sided facial paralysis due to Bell’s palsy for 7 years.The patient received an uncultured umbilical cord-derived mesenchymal stem cell transplant eight times for treatment.After follow-up for 32 mo,the paralysis was cured,and there was no recurrence.CONCLUSION Uncultured umbilical cord-derived mesenchymal stem cell transplantation may be a potential treatment for patients with Bell’s palsy who do not spontaneously recover.

Misdiagnosis of Facial Nerve Palsy: A Case Report of Sporadic Vestibular Schwannomas (Non-NFM2) Causing Facial Nerve Palsy Be Misled by Bell’s Palsy in a Child

We report a case of a rare sporadic Vestibular Schwannoma of a 9-month-old girl who had a right-sided lower motor type facial nerve palsy. The patient was initially diagnosed with Bell’s palsy and received steroid treatment accordingly, two months later the patient’s condition deteriorated, and further evaluation of CT and MRI brain was conducted that showed a mass lesion in the posterior fossa causing compression on the facial nerve. Misdiagnosis of facial nerve paralysis is common among children due to multiple related etiologies and varying rates of incidence in comparison to adults. The authors hope to address this issue in this report. Background: Facial nerve paralysis has been a matter of concern for many researchers to understand its nature, causes and presentation according to different age groups. In adults, Bell’s palsy (BP), the idiopathic form of facial nerve paralysis, is more common compared to children where most cases are due to secondary etiologies. Therefore, pediatricians are in an important position to identify these patients early in order to launch the most effective diagnostic and treatment approaches.

Bell’s Palsy Post COVID-19 Vaccination: A Retrospective Cross-Sectional Study in a Single Tertiary Center

Introduction: Bell’s palsy is an uncommon adverse effect of the COVID-19 vaccine that has been reported in clinical trials. Even though a few studies have linked the vaccination to Bell’s palsy, the actual mechanism is uncertain. Objectives: To describe the demographic data and COVID-19 vaccines-related data with Bell’s palsy in a tertiary centre of Malaysia, Hospital Kuala Lumpur. Methods: A retrospective cross-sectional study was observed among vaccinated recipients who developed Bell’s palsy within 60 days and sought treatment in the Otorhinolaryngology Department Hospital Kuala Lumpur, Malaysia between 1st May 2021 and 30th November 2021. The demographic data, clinical history, and vaccination history were collected from clinical records. The facial paralysis was graded according to the House-Brackmann grading system. Results: A total of 26 patients with a mean age was 38.5 years;higher incidence in younger age, below 60 years old (n = 24), specifically 18 - 30 years old (n = 11). We observed an equal number in relation to gender and onset (after the first or second dose) of facial palsy. Predominantly were Malay (n = 21) and only 6 patients had comorbidities. We found there was no difference in regard to the type of vaccine among Bell’s palsy patients;Pfizer (n = 9), followed by Sinovac (n = 9) and AstraZeneca (n = 8). Conclusion: Bell’s palsy was found to be a possible adverse event of the COVID-19 vaccine. Younger groups were noted as susceptible to this rare adverse effect. However, the benefits of vaccination outweigh the risk of Bell’s palsy, which has a good prognosis. More research with larger samples is needed to determine the true relationship between vaccination and Bell’s palsy.

PROF.ZHANG ANLI'S EXPERIENCE OF TREATING STUBBORN CASES OF FACIAL PALSY

Based on her own experience of many years＇ clinical practice, Prof. Zhang Anli summarized and created the method in which the shallow insertion at the upper eyelid, acupuncture at the Back-shu points and balanced selection of points together with the modified Setting Mountain on Fire and application of Fire Needle were applied for the treatment of stubborn cases of facial palsy. The therapeutic effect is good.

Infrared thermography and meridian-effect evidence and explanation in Bell's palsy patients treated by moxibustion at the Hegu (LI4) acupoint Overall regulation or a specific target?

Subjects with Bell＇s palsy and healthy individuals were treated with moxibustion thermal stimulation on the Hegu （LI4） acupoint; an infrared thermal imaging system was used to observe facial-temperature changes. Bell＇s palsy patients developed low or high temperatures at the affected side, with poor symmetry. Healthy people showed high temperatures on the forehead, medial angle of the eye, nasal ala and around the lips, but low temperatures on bilateral cheeks, thus forming a ＂T-type hot area＂ in the face, with good temperature symmetry. Moxibustion treatment for 11 minutes significantly improved high asymmetry in temperature in the faces of Bell＇s palsy patients. This evidence indicates that moxibustion treatment on Hegu enables increases in facial temperatures in healthy people and Bell＇s palsy patients, especially around the lips. Moxibustion stimulation at the Hegu not only improves the global circulation but also has specific effects on the lips in Bell＇s palsy patients, but the underlying mechanism needs further investigation.

Bell’s palsy workup:Does audiometry add value?

Objective:To investigate if routine audiometry in Bell’s palsy patients has prognostic value.Methods:Retrospective case review was conducted on all Bell’s palsy patients(n紏191)seen at the tertiary otolaryngology specialist outpatient clinic from 2015 to 2017.Correlation of ipsilesional audiometric thresholds with patients’time-to-recovery and initial clinical severity(measured by House-Brackmann(HB)scoring)were used for the prognostic outcome measure.Audiometry results were analyzed using three contiguous frequency pure-tone average(1kHz,2kHz,4kHz).Statistical analysis was done via Stata(v13.1),significance tests were 2-sided at 5%significance level.Results:There was no significant difference between audiometric thresholds between the ipsilesional ear and the contralateral ear(p=0.87).Time-to-recovery was significantly longer for patients with severe initial presentation as compared to mild and moderate severity(p<0.01).There was no correlation found between the audiometry results and HB score at presentation(p=0.39).There was no correlation found between ipsilesional audiometric thresholds and time-to-recovery(p=0.58).Conclusion:Our study suggests that routine audiometry has limited prognostic value in Bell’s palsy patients.

Psychological Factors Are Closely Associated with the Bell's Palsy: A Case-control Study

To observe the differences in psychological status between Bell’s palsy (BP) patients and healthy subjects, and to examine the relationship between psychological factors and the severity of BP, we conducted a case-control, multi-center clinical investigation. A total of 695 subjects were assigned to the case group (n=355) and the control group (n=340). House–Brackmann grading system and Facial Disability Index (FDI) were adopted to assess the BP patients; Kessler Psychological Distress Scale (K10) and 16 Personality Factor (16PF) scale were employed to evaluate the psychological distress and personality profiles of all subjects. Two independent samples t test was used to compare the differences between cases and controls, and to compare the differences among different BP patients. Pearson correlation analysis was used to examine the relationship between psychological factors and severity of facial paralysis. The results showed that psychological distress (K10) in case group (27.09±5.80) was significantly higher than that in control group (13.43±3.02) (t=–37.219, P=0.000). The scores of personality factor Warmth (A), Openness to Change (Q1), Self-Reliance (Q2) were lower in cases than in the controls (P<0.01, P<0.05, P<0.05, respectively), whereas the scores of Sensitivity (I), Vigilance (L), Apprehension (O), and Tension (Q4) were significantly higher in cases than in the controls (P<0.05, P<0.01, P<0.01, P<0.01, respectively). In addition, the psychological distress was significantly higher in female patients, severe (HB score Ⅳ–Ⅵ) patients, and subacute (onset time 72–168 h) patients compared with that in male patients, mild (HB score Ⅰ–Ⅲ)patients, and acute (onset time≤72 h) patients (P<0.05). The scores of personality factor in female patients, severe patients, and subacute patients were also significantly different from male patients, mild patients, and acute patients (P<0.05). The result of Pearson correlation analysis showed that psychological factors (K10, personality A, F, L, N, O, Q4) were closely related to HB scores. We are led to conclude that the psychological status between BP patients and healthy people are different; psychological distress and personality factors are closely associated with severity of facial paralysis.

Acupuncture and vitamin B_(12) injection for Bell's palsy:no high-quality evidence exists

OBJECTIVE： To assess the efficacy of acupuncture combined with vitamin B12 acupoint injection versus acupuncture alone to reduce incomplete recovery in patients with Bell＇s palsy. DATA RETRIEVAL： A computer-based online retrieval of Medline, Web of Science, CNKI, CBM databases until April 2014 was performed for relevant trials, using the key words ＂Bell＇s palsy or idiopathic facial palsy or facial palsy＂ and＂acupuncture or vitamin B12 or methylcobalamin＂. STUDY SELECTION： All randomized controlled trials that compared acupuncture with acupuncture combined with vitamin B12 in patients with Bell＇s palsy were included in the me- ta-analysis. The initial treatment lasted for at least 4 weeks. The outcomes of incomplete facial recovery were monitored. The scoring index varied and the definition of healing was consistent. The combined effect size was calculated by using relative risk （RR） with 95% confidence interval （C/） using the fixed effect model of Review Manager. MAIN OUTCOME MEASURES： Incomplete recovery rates were chosen as the primary outcome. RESULTS： Five studies involving 344 patients were included in the final analysis. Results showed that the incomplete recovery rate of Bell＇s palsy patients was 44.50% in the acupuncture combined with vitamin B12 group but 62.57% in the acupuncture alone group. The major acupoints were Taiyang （EX-HN5）, Jiache （ST6）, Dicang （ST4） and Sibai （ST2）. The combined effect size showed that acupuncture combined with vitamin B12 was better than acupuncture alone for the treatment of Belrs palsy （RR = 0.71, 95%CI： 0.58-0.87; P = 0.001）, this result held true when 8 patients lost to follow up in one study were included into the analyses （RR = 0.70, 95%CI： 0.58-0.86; P = 0.0005）. In the subgroup analyses, the therapeutic effect in patients of the electroacupuncture subgroup was better than in the non-electroacupuncture subgroup （P = 0.024）. There was no significant dif- ference in the incomplete recovery rate by subgroup analysis on drug types and treatment period. Most of the included studies were moderate or low quality, and bias existed. CONCLUSION： In patients with Bell＇s palsy, acupuncture combined with vitamin 812 can reduce the risk of incomplete recovery compared with acupuncture alone in our meta-analysis. Because of study bias and methodological limitations, this conclusion is uncertain and the clinical appli- cation of acupuncture combined with vitamin B12 requires further exploration.

Bell's palsy at high altitude——an unsuspected finding

Background:Bell's palsy is a common condition seen in clinical practice.The aetiology of this condition is not clearly defined and neuroimaging is essential to exclude intracranial causes of infra-nuclear facial palsy.Case presentation:We report a young soldier,who presented with Bell's palsy and neuroimaging revealed an unsuspected finding of multiple intracranial calcifications.Detailed evaluation revealed the additional diagnosis of vitamin D deficiency and secondary hyperparathyroidism due to lack of sun exposure at high altitude area.Conclusion:The health care practitioners,looking after the soldiers at high altitude areas should be aware of the measures to prevent vitamin D deficiency.Intracranial calcifications are uncommon in hyperparathyroidism and Bell's palsy.

Bell’s palsy and choreiform movements during peginterferon α and ribavirin therapy

Neuropsychiatric side effects of long-term recombinant interferon-α therapy consist of a large spectrum of symptoms. In the literature, cranial neuropathy, especially Bell's palsy, and movement disorders, have been reported much less often than other neurotoxic effects. We report a case of Bell's palsy in a patient with chronic hepatitis C during peginterferon-α and ribavirin therapy. The patient subsequently developed clinically inapparent facial nerve involvement on the contralateral side and showed an increase in choreic movements related to Huntington's disease during treatment.

Bell’s palsy after inactivated COVID-19 vaccination in a patient with history of recurrent Bell’s palsy: A case report

BACKGROUND With rapid and extensive administration of inactivated coronavirus disease 2019(COVID-19)vaccine to the general population in China,it is crucial for clinicians to recognize neurological complications or other side effects associated with COVID-19 vaccination.CASE SUMMARY Here we report the first case of Bell’s palsy after the first dose of inactivated COVID-19 vaccine in China.The patient was a 36-year-old woman with a past history of Bell’s palsy.Two days after receiving the first dose of the Sinovac Life Sciences inactivated COVID-19 vaccine,the patient developed right-side Bell’s palsy and binoculus keratoconjunctivitis.Prednisone,artificial tears and fluorometholone eye drops were applied.The patient’s symptoms began to improve by day 7 and resolved by day 54.CONCLUSION As mRNA COVID-19 vaccine trials reported cases of Bell’s palsy as adverse events,we should pay attention to the occurrence of Bell’s palsy after inactivated COVID-19 vaccination.A history of Bell’s palsy,rapid increase of immunoglobulin M and immunoglobin G-specific antibodies to severe acute respiratory syndrome coronavirus 2 may be risk factors for Bell‘s palsy after COVID-19 vaccination.

Does Beta Thalassemia Increase the Incidence of Bell＇s Palsy？

A five-year old Iraqi patient with beta thalassemia major was presented with recurrent attack of Bell＇s palsy on 2 successive years being a milder one in the second year. This is a rare occurrence in beta thalassemia major patients and needs to be further explored. This is a case report of a nine-year old Iraqi child who is the only child born to parents of secondary consanguinity relatives from Babil Province who was diagnosed as beta thalassemia on the age of 6 months and is on regular blood transfusion and iron chelation therapy of deferasirox tablets （Exjade）, his medical follow up takes place at Babil Thalassemia center in Babil Maternity and Child Hospital. On the age of five years, he was presented with a sudden onset of right sided Bell＇s palsy within twenty four hours of swimming in a cool swimming pool at his home in July 2011. A neurosurgeon examined him at that time, no investigations were done, the diagnosis was purely clinical, steroid ＆ neurotonics were recommended as a treatment for the condition, antiviral agents were not prescribed, lacrimation ＆ taste were not affected, there was a slow improvement, two weeks later physiotherapy sessions including facial massage ad electric stimulation were recommended after which the child improved. The next year, another attach of Bell＇s Palsy developed at a similar time with the same sequel of events, this time the attack was milder and with residual effects seen in the eye ＆ mouth. This coincidence of beta thalassemia and Bell＇s palsy should be further studied by observational epidemiologic studies to prove or disprove the hypothesis that thalassemic patients especially children are at higher risk of developing Bell＇s palsy than healthy children. Beta thalassemia patients may be at higher risk of developing Bell＇s Palsy.

Metaphysical Energy Therapy in the Treatment of Cranial Nerve Palsies with Special Reference to Bell’s Palsy

Neuropathy, or nerve injury, is a severe and common impediment of diabetes. Studies evaluate that 50% of people with diabetes will develop neuropathy. Diabetic nerve injury is impairment of a single solitary nerve (also named mononeuropathy). Com- monly 2 cranial nerves Viz., cranial nerve VII and cranial nerve VI are involved in facial nerve palsies. The former one is called Bell’s palsy and is acute Lower Motor Neuron facial nerve paralysis (>80%) causing an inability to control facial muscles on the affected side. The later one is sixth nerve palsy, (the abducens nerve), which is responsible for triggering contraction of the lateral rectus muscle to abduct (i.e., turn out) the eye resulting in double vision on the affected side. In recent times, we have found to our amazement, rapid restoration of normalcy within a few hours to a few days, of Cranial Nerve palsies in diabetic subjects at our centre. We are presenting a group of cases having Type2DM over different time periods from 6 to 20 years and those who suddenly suffered facial nerve palsy and they came to VHSDRC for treatment. They were started on the new modality called the Dynamic Acupuncture Mediated Meta-physical Energy Therapy (DAMM Therapy), to recover from the facial palsy. The DAMM therapy is a unique novel way of infusing and transferring healing energy from the therapist to the patient. Within 2 - 7 sittings of DAMM therapy patients showed 75% - 100% improvement in their clinical condition.

激光散斑成像技术观察浮针治疗急性贝尔面瘫案:病例报道

One case of acute Bell’s palsy was reported and treated with Fu’s subcutaneous needling(FSN).Present symptoms:facial muscle stiffness on the right side,ptosis of labial angle,failure to frown the right eyebrow,the eyeball exposed about 2 mm when gently closing the eyes,air leaking when bulging the cheeks,drooling when brushing the teeth and gargling,and food retained in the cheek when eating.Western medicine diagnosis:peripheral facial palsy.Traditional Chinese medicine diagnosis:facial paralysis.The subcutaneous swaying movement and reperfusion action of FSN were adopted on the affected muscles and achieved the remarkably effects on incomplete closure of eyes and drooping of the mouth.The patient was recovered quickly.Before and after treatment,the laser speckle contrast imaging was used to observe the improvement of blood flow on the face,which provides the idea for the research and clinical practice of Fu’s subcutaneous needling in treatment of Bell’s palsy.

Warm needling moxibustion at Xià guān(下关 ST 7) plus shallow Puncture for Bell's palsy in pregnancy

Objective To observe the effects of a protocol consisting of warm needling with moxibustion at Xiàguān（下关 ST 7） plus shallow puncture on Bell＇s palsy（BP） in pregnancy.Methods Thirteen patients with BP received an intervention of warm needling moxibustion at ST 7 plus shallow puncture,and were evaluated using the House–Brackmann facial nerve grading system（HB） before and after intervention.Result After intervention,the HB grade improved significantly（P0.05）.Conclusion Warm needling moxibustion plus shallow puncture is a safe and effective therapy for pregnant BP patients.BP in pregnancy appears to be more frequent in the last trimester.The severity of nerve injury and the timing for the first visit to the doctor after the onset of facial paralysis are essential factors for the recovery and prognosis of pregnant with BP.

Observation on the therapeutic effect of time-oriented points opening of Linggui Bafa for Bell's palsy

Objective To evaluate the therapeutic effect and safety of time-oriented points opening of Linggui Bafa for Bell＇s palsy and provide a new idea for the clinical treatment of this problem. Methods Fifty-four cases included in the study were randomized into two groups, and the treatment group was treated with the routine acupuncture combined with time-oriented points opening of Linggui Bafa. The control group was treated with the routine acupuncture only, Hegu （合谷 El 4）, Kunlun （昆仑 BL 60）, Jiache （颊车 ST 6）, Dicang （地仓 ST 4）, Xiaguan （下关 ST 7）, Cuanzhu （攒竹 BL 2）, Yangbai （附白 GB 14）, and Quanliao （颧髎 SI 18） were selected as the main points. The manipulation and time of retaining needles were as same as the treatment group. Both groups were treated once a day, 5 days made one session and 4 sessions were required in all. Modified Portmann＇s scale, Horse-Brackmann grading scale （H-B）, FDIP and FDIS were used to assess the therapeutic effect after the treatment. Results The curative and improvement rate in the treatment group was 80.8% （22/26）, and that in the control group was 66.7% （16/24）, with the statistically significant difference （P〈O.05）, the comparison of scores of Portmann＇s scale, H-B, FDIP and FDIS in the same group and between the two groups before and after the treatment also had statistically significant differences （all P〈0.05）. Conclusion The method of time-oriented points opening of Linggui Bafa for Bell＇s palsy is better than the routine acupuncture for Bell＇s palsy.

Efficacy of acupuncture and moxibustion in treating Bell’s palsy: a multicenter randomized controlled trial in China

Background Bell’s palsy involves acute facial paralysis due to inflammation of the facial nerve. Acupuncture and moxibustion (acu-moxi) is beneficial in treating facial palsy. In order to verify the efficacy of acu-moxi on Bell’s palsy, a randomized single-blind, multicenter clinical trial was performed.Methods A total of 480 patients from four clinical centers were involved in this trial, of whom 439 completed the trial and 41 did not. All patients were randomly assigned to either the control group or to one of two treatment groups. The control group was treated with prednisone, vitamin B_1, vitamin B_ 12, and dibazole; the treatment groups were treated either with acu-moxi alone or in combination with prednisone, Vitamin B_1, vitamin B_ 12, and dibazole. Symptoms and signs, the House-Brackmann scale, and facial disability index (FDI) scores were assessed and determined both pre- and post-treatment to evaluate the effectiveness of the treatment methods.Results The characteristics of the control and two treatment groups were comparable without statistically significant differences before treatment. There were significant differences between the control and treatment groups after treatment (χ2=15.265, P=0.018). According to evaluations based on the House-Brackmann scale and FDI scores, the effectiveness of treatment in the two treatment groups was better than in the control group and was most effective in patients receiving acu-moxi treatment alone (Z=-2.827, P=0.005). Conclusion The efficacy of acu-moxi treatment for Bell’s palsy is verified scientifically.

Electrical response grading versus House-Brackmannscale for evaluation of facial nerve injury after Bell's palsy: a comparative study

OBJECTIVE： There are no convenient techniques to evaluate the degree of facial nerve injury during a course of acupuncture treatment for Bell＇s palsy. Our previous studies found that observing the electrical response of specific facial muscles provided reasonable correlation with the prognosis of electroacupuncture treatment. Hence, we used the new method to evaluate the degree of facial nerve injury in patients with Bell＇s palsy in comparison with the House-Brackmann scale. The relationship between therapeutic effects and prognosis was analyzed to explore an objective method for evaluating Bell＇s palsy. METHODS： The facial nerve function of 68 patients with Bell＇s palsy was assessed with both electrical response grading and the House-Brackmann scale before treatment. Then differences in evaluation results of the two methods were compared. All enrolled patients received electroacupuncture treatment with disperse-dense wave at 1/100 Hz for 4 weeks. After treatment, correlation analysis was conducted to find the relationship between electrical response and therapeutic effects or prognosis. RESULTS： Checking consistency between electrical response grading and House-Brackmann scale： Kappa value 0.028 （P = 0.578）. Correlation analysis： the two methods were correlated with the prognosis, and electrical response grading （rER = 0.789） was better than the House-Brackmann scale （rHB = 0.423）. CONCLUSION： Electrical response grading is superior to the House-Brackmann scale in efficacy and reliability, and can conveniently assess the degree of facial nerve injury. The House-Brackmann scale is suitable for the patients with mild facial nerve injury, but its evaluation quality for severe facial nerve injury is poor.

Needle Sensation and Personality Factors Influence Therapeutic Effect of Acupuncture for Treating Bell＇s Palsy： A Secondary Analysis of a Multicenter Randomized Controlled Trial

Background： It has not been solved what kind of needle sensation might influence outcomes of acupuncture treatment. Effects of personality factors on the therapeutic effect of acupuncture have not been investigated. This study aimed to find the effects of the traits of personality on the objective outcome when different acupuncture techniques were used in treating patients with Bell＇s palsy. Methods： We performed a secondary analysis of a prospective multicenter randomized controlled trial of acupuncture for Bell＇s palsy. Patients were randomly assigned to the de qi and control groups, respectively. The primary outcome was facial nerve function at month 6. The intensity of each needle sensation was rated by a visual analog scale. Psychosocial thctors were assessed by the pretreatment mediator questionnaire： 16 Personality Factor Questionnaire （16PF） was used tbr assessing personality factors and digit cancellation test for assessing attention. Results： After 6 months, patients in the de qi group had better facial function （adjusted odds ratio [OR]： 4.16, 95% confidence interval [CI]： 2.23-7.78）. Path analysis showed that intensity of needle sensation of fullness had direct effect on House-Brackmann （HB） score at month 6. In de qi group, the low HB score on day I （OR： 0.13, 95% （_7： 0.03-0.45） and the low Social Boldness score （OR： 0.63, 95% CI： 0.41-0.97） in 16PF were associated with better facial function. In control group, low HB score on day 1 （OR： 0.25, 95% CI： 0.13-0.50）, low Vigilance score （OR： 0.66, 95% CI： 0.50-0.88）, and high Tension score （OR： 1.41,95% CI： 1.12 1.77） in 16PF were related to better facial function. Conclusions： The needle sensation of fullness could predict better facial function and personality traits might influence outcomes of acupuncture treatment. Both of them should be considered seriously in acupuncture treatment and research.

Acupuncture for Bell's Palsy:A Systematic Review and Meta-analysis

Objective： To assess the clinical evidence for and against acupuncture as a treatment for Bell＇s palsy. Methods： We conducted a literature search of 15 databases from their inception to December 2010 without language restrictions. We included all randomized clinical trials （RCTs） regardless of their controls. Methodological quality was evaluated using the Cochrane risk of bias assessment tool. Results： Of the 3 474 articles, only eight RCTs met our inclusion criteria. Four RCTs tested the effects of acupuncture against drug therapy on disease response rate. The meta-analysis of these data showed significant improvements in the acupuncture group [n=463, risk ratio （RR）=1.07, 95% CI： 1.02 to 1.13; P=0.006, I^2=0%]. Six RCTs tested the effects of acupuncture plus drug therapy versus drug therapy alone. The meta-analysis of this set of RCTs also showed the favorable effects of acupuncture on disease response rate （n=512, RR=1.11, 95% CI： 1.05 to 1.17; P=0.001, I^2=13%）. Conclusions： The evidence supporting the effectiveness of acupuncture for treating Bell＇s palsy is limited. The number and quality of trials are too low to form firm conclusions. Further rigorous RCTs are warranted but need to overcome the many limitations of the current evidence.