In December 2021 and March 2022, patients with faci-al paralysis who applied to our outpatient clinics of physical medicine and rehabilitation and otolaryngology were included in the study.
This study was planned as cross-sectional. Approval was obtained from the Ethics committee of Gazi Yaşargil Training and Research Hospital. All patients signed the informed consent form after the objectives and methods of the study were explained to them. The patients were examined after signing the informed consent form by experienced physicians. Physicians assessed whether patients were eligible to participate in the study. Magnetic resonance imaging, magnetic reso-nance angiography, computed tomography, and elec-tromyography were used in the examination. In addi-tion, the hearing functions of the patients were evaluat-ed before all the tests. Persons with impaired hearing functions were not included in the study.
Forty patients aged 18 years and over who were diagnosed with facial paralysis and whose sequelae contin-ued despite the completion of clinical treatment were included in the study. Demographic characteristics of the participants such as age, gender, marital status, profession, education status, height, and weight were recorded.
Persons with a disease related to the central nervous system, current Bell's palsy, concomitant movement disorders, heart failure, pulmonary, renal, or hepatic insufficiency, or any malignancy were excluded from the study. In addition, patients with cognitive impair-ment, which led to the inability to answer the questions asked reliably, were not included in the study.
Eighty people, including 40 cases and 40 controls, participated in the study. There are 20 women and 20 men in the case group, while 21 women and 19 men are in the control group. The mean age of the case group was 37.35, the standard deviation was 6.71, the mean age of the control group was 36.475, and the standard deviation was 7.77. While 21 of the case group were married and had undergraduate education level, it revealed that 17 of the control group were married and 18 were undergraduates.
The patients were evaluated with the House-Brackmann scale. The Liebowitz social phobia symptoms scale was used to measure the level of social phobia.
House-Brackmann Scale
The House-Brackmann Scale is an analysis tool developed to evaluate facial functions and determine the degree of paresis/paralysis globally. The House-Brackmann scale was first defined in 1985 in Los An-geles by otolaryngologists Dr. John W. House and Dr. Derald E. Brackmann. It is a widely accepted system. Its application is simple. However, it is sensitive, gives accurate results, and is reliable.
The scale was translated into Turkish by two independent researchers at the beginning. After that, two researchers came together and completed the final ver-sion of the translation. Another researcher specializing in neurotology has translated the Turkish version of the scale back into English. At these stages, validity and reliability tests have been completed.
When calculating the score, the upward movement of the middle of the eyebrow and the outward movement of the oral commissure are taken as a basis. 1 point is given for every 0.25 cm movement up to a maximum of 1 cm for eyebrow and oral commissure movement. If the structures can be moved by 1 cm in both move-ments, 8 points are scored, the maximum score. From the point of view of its objectivity, movements are made both on the normal and affected sides.
Facial functions are graded in 6 stages according to the scores obtained. H-B1 indicates that facial functions are normal, and H-B6 indicates that there is total paralysis6-8.
Liebowitz Social Phobia Symptoms Scale
Michael Liebowitz developed the Liebowitz Social Phobia Symptoms Scale in 1987 to evaluate the social relationship and performance situations in which indi-viduals with social phobia exhibit fear and/or avoidance behavior. The validity and reliability studies of the scale were conducted by Heimberg et al.9, and the validity and reliability study of the Turkish form was conducted by Soykan et al.10. The Cronbach alpha coefficient for the whole scale was found to be 0.98. The Cronbach's alpha coefficient for the fear or anxiety and avoidance subscales is 0.96 and 0.95, re-spectively11.
There are 24 items on the scale, 11 of which are social relations and 13 of which are performance. The scale consists of Likert-type items scored between 1-4. The total score is obtained by summing the fear and avoid-ance scores12. 55-65 points indicate mild social phobia, 65-80 points indicate moderate social phobia, 80-95 points indicate severe social phobia and 95+ points indicate very severe social phobia13.
Statistical Analysis
Calculations were made with the SPSS 18 (SPSS, Chi-cago, Ill., USA). Kolmogorov-Smirnov test was used to evaluate whether the data were in accordance with the normal distribution. Comparisons between the groups were made using the independent samples t-test or the Mann Whitney U test according to the suitability of the data for the normal distribution. The difference between the proportional variables was calculated using the Chi-square test. Spearman correlation analysis assessed the relationship between facial paralysis and social phobia development. p< 0.05 and 95% confi-dence interval were considered statistically significant.