Objective: To observe the clinical effect of repetitive transcranial acupuncture stimulation (rTAS) combined with electroacupuncture (EA) in treatment of acute facial palsy with retroauricular pain.
Methods: Sixty-eight patients of acute facial palsy with retroauricular pain were randomly divided into an observation group (34 cases, 3 cases dropped out) and a control group (34 cases, 3 cases dropped out). On the basis of conventional therapy, in the control group, Yangbai (GB 14), Cuanzhu (BL 2), Sibai (ST 2), Quanliao (SI 18), Dicang (ST 4), Yifeng (TE 17), Qianzheng (Extra point) and Taiyang (EX-HN 5) on the affected side, and bilateral Hegu (LI 4) were selected. EA was attached to Yangbai (GB 14) and Cuanzhu (BL 2), and Sibai (ST 2) and Dicang (ST 4), respectively, using intermittent wave. In the observation group, on the basis of the regimen as the control group, rTAS was delivered at Baihui (GV 20) and the 1/5 of the lower motor area on the bilateral sides; EA of dense wave was given at the sites of the mastoidⅠand Ⅱ. The intervention of each group was delivered once a day, 6 times a week as one course for 4 courses and taking a day off every course. Before treatment and at the moment after the first treatment completion, the score of visual analogue scale (VAS) was observed in the two groups and the days of retroauricular pain were recorded. Before and after treatment, the score of Sunnybrook facial grading system (SFGS), the grade of House-Brackmann facial nerve function evaluation system (H-B), the latency and amplitude of the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve, were observed in the patients of two groups and the clinical effect was compared between the two groups after treatment.
Results: After treatment, SFGS score was increased (P<0.05), H-B grade was improved (P<0.05), the latency was shortened in the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve (P<0.05) and its amplitude elevated (P<0.05) when compared with those before treatment in the two groups. In the observation group, SFGS score was higher (P<0.05), H-B grade was superior (P<0.05), the latency was shorter in the motor conduction from the foramina stylomastoideum to the frontal muscle, the orbicularis oris muscle and the orbicularis oculi muscle on the affected facial nerve (P<0.05) and its amplitude was higher (P<0.05) when compared with those of the control group after treatment. After the completion of the first treatment, VAS score of either group was reduced in comparison with that before treatment (P<0.05), and the score in the observation group was lower than that of the control group (P<0.05). The duration of retroauricular pain was shortened in the observation group when compared with that of the control group (P<0.05). The total effective rate was 87.1% (27/31) in the observation group, which was higher than 77.4% (24/31) of the control group (P<0.05).
Conclusion: The rTAS combined with EA is effective for reducing neurologic impairment of acute facial palsy and alleviating retroauricular pain in the patients.
目的：观察经颅重复针刺法结合电针治疗伴耳后疼痛的急性面神经麻痹的疗效。方法：将68例伴耳后疼痛的急性面神经麻痹患者随机分为观察组（34例，脱落3例）和对照组（34例，脱落3例）。两组均给予基础治疗。对照组穴取患侧阳白、攒竹、四白、颧髎、地仓、翳风、牵正、太阳，双侧合谷，阳白和攒竹、四白和地仓分别连接电针，选用断续波；观察组在对照组治疗基础上，于百会、双侧运动区下1/5应用经颅重复针刺法，乳突1穴、乳突2穴连接电针，选用密波。两组治疗均每天1次，每周6次为一疗程，疗程间休息1 d，共治疗4个疗程。观察两组患者治疗前及首次治疗后即刻视觉模拟量表（VAS）评分，并记录耳后疼痛持续天数；观察两组患者治疗前后Sunnybrook面神经评定系统评分、House-Brackmann（H-B）面神经功能分级及患侧面神经从茎乳孔至额肌、口轮匝肌、眼轮匝肌的运动传导的潜伏期、波幅，并于治疗后比较两组临床疗效。结果：与治疗前比较，治疗后两组患者Sunnybrook面神经评定系统评分升高(P<0.05)，H-B面神经功能分级改善（P<0.05），患侧面神经茎乳孔至额肌、口轮匝肌与眼轮匝肌运动传导的潜伏期缩短（P<0.05），波幅升高（P<0.05）；治疗后，观察组患者Sunnybrook面神经评定系统评分高于对照组(P<0.05)，H-B面神经功能分级优于对照组（P<0.05），患侧面神经茎乳孔至额肌、口轮匝肌与眼轮匝肌运动传导的潜伏期短于对照组（P<0.05），波幅高于对照组（P<0.05）。首次治疗后两组患者耳后疼痛VAS评分较治疗前降低（P<0.05），且观察组低于对照组（P<0.05）。观察组耳后疼痛持续时间短于对照组（P<0.05）。观察组总有效率为87.1%（27/31），高于对照组的77.4%（24/31，P<0.05）。结论：经颅重复针刺法结合电针能够改善急性面神经麻痹患者神经功能缺损症状，减轻耳后疼痛。.
Keywords: acute facial palsy; electroacupuncture; randomized controlled trial (RCT); repetitive transcranial acupuncture stimulation; retroauricular pain; two points at mastoid region.