The SARS-CoV-2 virus outbreak in 2020 continues to be investigated as well as its after-effects on those infected by it. The vaccines created for the public were groundbreaking achievements, evidenced by the lives saved by them and the return to normality of ending social distancing and the pandemic. Otolaryngologists have become particularly intrigued due to SARS-CoV-2’s effect on sense of smell, taste, and link with facial nerve palsy. However, there are reported cases and studies which suggested patients develop facial nerve palsy after receiving their SARS-CoV-2 vaccination as well. The term ‘Bell’s palsy’ (BP) is essentially a diagnosis of exclusion after ruling out other causes of facial nerve palsy. Our medical colleagues in Iran carried out the first systemic review and meta-analysis on the incidence of Bell’s palsy subsequent to SARS-CoV-2 vaccination. Although the SARS-CoV-2 vaccination has shown significant value, there were and are discussions about its side effects and complications. This paper focuses on the incidence of BP. There were 50 studies pooled ultimately, with 17 that underwent meta-analysis, with vaccinated and control groups. The other studies underwent systemic review. The data extracted was vast and included the vaccine type, demographics and BP-related clinical variables such as physical examination, laterality, duration of event from vaccination, treatment and outcomes. The study results indicate the incidence of BP was significantly higher in those vaccinated against SARS-CoV-2 compared to placebo and did not vary between the types of vaccine received. Importantly, the study showed the risk of developing BP subsequent to SARS-CoV-2 infection was markedly more significant than after receiving the vaccination. The authors analyse the possible mechanisms to understand the pathophysiology of BP in those infected by SARs-CoV-2, such as peri-neural inflammation and compression in the temporal bone due to the virus. The study is limited in a few ways, which have been highlighted by the authors. Specifically, some of the studies did not split the first and second vaccination doses, therefore their analysis was combined data and would affect the timeline of events. Due to the pandemic and active reporting of adverse outcomes, reporting bias was at an all-time high, which may skew also results. There is still high heterogeneity amongst studies looking at SARS-CoV-2, but this study helps readers appreciate the significance of BP from the vaccine and virus. Continued research is required to verify associations.
COVID vaccination and its relation to Bell’s palsy
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