A patient with Bell's palsy presenting with complete facial paralysis (House-Brackmann grade VI) after 10 days is being considered for electrophysiological prognostication. Electroneuronography (ENoG) showing >90% degeneration before day 14 correlates with which prognosis?

• A Excellent prognosis — complete recovery within 3 months regardless
• B Good prognosis if steroids are started at this point
• C Indicates surgical decompression is universally curative
• D Poor prognosis — suggests extensive Wallerian degeneration with risk of incomplete recovery and synkinesis ✓

Explanation

ENoG degeneration >90% within 14 days of Bell's palsy onset indicates severe Wallerian degeneration of the facial nerve and correlates with a significantly poorer prognosis — only 50% achieve full recovery, and many develop synkinesis. ENoG <90% degeneration predicts near-complete recovery. This prognostic threshold guides the decision regarding surgical decompression, which some authorities advocate (via middle cranial fossa approach) for cases with >90% degeneration within 14 days, though evidence remains controversial.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.