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Original Investigation
August 2018

Speech and Communicative Participation in Patients With Facial Paralysis

Author Affiliations
  • 1Keck School of Medicine, University of Southern California, Los Angeles
  • 2Department of Otolaryngology–Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles
  • 3Department of Otolaryngology–Head and Neck Surgery, University of Southern California Voice Center, Los Angeles
  • 4Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Stanford University Medical Center, Stanford, California
JAMA Otolaryngol Head Neck Surg. 2018;144(8):686-693. doi:10.1001/jamaoto.2018.0649
Key Points

Question  What is the influence of facial paresis or paralysis on speech and communicative participation?

Findings  In this nationwide online survey of patients with unilateral facial paresis or paralysis, respondents reported restrictions in communicative participation that were comparable with restrictions experienced by patients with known causes of communication disorders, such as laryngectomy and head and neck cancers.

Meaning  Impaired communicative participation may represent a unique domain of dysfunction in facial paralysis; measurement of communicative participation can help quantify the influence of facial paralysis on daily living as well as provide an additional frame of reference when setting goals of care and assessing outcomes of treatment.

Abstract

Importance  Problems with speech in patients with facial paralysis are frequently noted by both clinicians and the patients themselves, but limited research exists describing how facial paralysis affects verbal communication.

Objective  To assess the influence of facial paralysis on communicative participation.

Design, Setting, and Participants  A nationwide online survey of 160 adults with unilateral facial paralysis was conducted from March 1 to June 1, 2017. To assess communicative participation, respondents completed the Communicative Participation Item Bank (CPIB) Short Form questionnaire and the Facial Clinimetric Evaluation (FaCE) Scale.

Main Outcomes and Measures  The CPIB Short Form and the correlation between the CPIB Short Form and FaCE Scale. In the CPIB, the level of interference in communication is rated on a 4-point Likert scale (where not at all = 3, a little = 2, quite a bit = 1, and very much = 0). Total scores for the 10 items range from 0 (worst) to 30 (best). The FaCE Scale is a 15-item instrument that produces an overall score ranging from 0 (worst) to 100 (best), with higher scores representing better function and higher quality of life.

Results  Of the 160 respondents, 145 (90.6%) were women and 15 were men (mean [SD] age, 45.1 [12.6] years). Most respondents reported having facial paralysis for more than 3 years. Causes of facial paralysis included Bell palsy (86 [53.8%]), tumor (41 [25.6%]), and other causes (33 [20.6%]), including infection, trauma, congenital defects, and surgical complications. The mean (SD) score on the CPIB Short Form was 0.16 (0.88) logits (range, –2.58 to 2.10 logits). The mean (SD) score of the FaCE Scale was 40.92 (16.05) (range, 0-83.3). Significant correlations were observed between the CPIB Short Form and overall FaCE Scale scores, as well as the Social Function, Oral Function, Facial Comfort, and Eye Comfort subdomains of the FaCE Scale, but not with the Facial Movement subdomain.

Conclusions and Relevance  Patients with facial paralysis in this study sample reported restrictions in communicative participation that were comparable with restrictions experienced by patients with other known communicative disorders, such as laryngectomy and head and neck cancer. We believe that communicative participation represents a unique domain of dysfunction and can help quantify the outcome of facial paralysis and provide an additional frame of reference when assessing treatment outcomes.

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