{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:07:53Z","timestamp":1792796873835,"version":"4.5.0"},"reference-count":116,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:sec id=\"ab-ooi230005-4\"><jats:title>Importance<\/jats:title><jats:p>Bell palsy (BP) has been reported as an adverse event following the SARS-CoV-2 vaccination, but neither a causative relationship nor a higher prevalence than in the general population has been established.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230005-5\"><jats:title>Objective<\/jats:title><jats:p>To compare the incidence of BP in SARS-CoV-2 vaccine recipients vs unvaccinated individuals or placebo recipients.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230005-6\"><jats:title>Data Sources<\/jats:title><jats:p>A systematic search of MEDLINE (via PubMed), Web of Science, Scopus, Cochrane Library, and Google Scholar from the inception of the COVID-19 report (December 2019) to August 15, 2022.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230005-7\"><jats:title>Study Selection<\/jats:title><jats:p>Articles reporting BP incidence with SARS-CoV-2 vaccination were included.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230005-8\"><jats:title>Data Extraction and Synthesis<\/jats:title><jats:p>This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and was conducted with the random- and fixed-effect models using the Mantel-Haenszel method. The quality of the studies was evaluated by the Newcastle-Ottawa Scale.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230005-9\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>The outcomes of interest were to compare BP incidence among (1) SARS-CoV-2 vaccine recipients, (2) nonrecipients in the placebo or unvaccinated cohorts, (3) different types of SARS-CoV-2 vaccines, and (4) SARS-CoV-2\u2013infected vs SARS-CoV-2\u2013vaccinated individuals.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230005-10\"><jats:title>Results<\/jats:title><jats:p>Fifty studies were included, of which 17 entered the quantitative synthesis. Pooling 4 phase 3 randomized clinical trials showed significantly higher BP in recipients of SARS-CoV-2 vaccines (77\u202f525 vaccine recipients vs 66\u202f682 placebo recipients; odds ratio [OR], 3.00; 95% CI, 1.10-8.18; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%). There was, however, no significant increase in BP after administration of the messenger RNA SARS-CoV-2 vaccine in pooling 8 observational studies (13\u202f518\u202f026 doses vs 13\u202f510\u202f701 unvaccinated; OR, 0.70; 95% CI, 0.42-1.16; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200994%). No significant difference was found in BP among 22\u202f978\u202f880 first-dose recipients of the Pfizer\/BioNTech vaccine compared with 22\u202f978\u202f880 first-dose recipients of the Oxford\/AstraZeneca vaccine (OR, 0.97; 95% CI, 0.82-1.15; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090%). Bell palsy was significantly more common after SARS-CoV-2 infection (n\u2009=\u20092\u202f822\u202f072) than after SARS-CoV-2 vaccinations (n\u2009=\u200937\u202f912\u202f410) (relative risk, 3.23; 95% CI, 1.57-6.62; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200995%).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230005-11\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This systematic review and meta-analysis suggests a higher incidence of BP among SARS-CoV-2\u2013vaccinated vs placebo groups. The occurrence of BP did not differ significantly between recipients of the Pfizer\/BioNTech vs Oxford\/AstraZeneca vaccines. SARS-CoV-2 infection posed a significantly greater risk for BP than SARS-CoV-2 vaccination.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2023.0160","type":"journal-article","created":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T15:35:09Z","timestamp":1682609709000},"page":"493","source":"Crossref","is-referenced-by-count":45,"title":["Association of SARS-CoV-2 Vaccination or Infection With Bell Palsy"],"prefix":"10.1001","volume":"149","author":[{"given":"Ali","family":"Rafati","sequence":"first","affiliation":[{"name":"School of Medicine, Iran University of Medical Sciences, Tehran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeganeh","family":"Pasebani","sequence":"additional","affiliation":[{"name":"School of Medicine, Iran University of Medical Sciences, Tehran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melika","family":"Jameie","sequence":"additional","affiliation":[{"name":"Iranian Center of Neurological Research, Neuroscience 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Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mobina","family":"Amanollahi","sequence":"additional","affiliation":[{"name":"Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delaram","family":"Sakhaei","sequence":"additional","affiliation":[{"name":"School of Medicine, Sari Branch, Islamic Azad University, Sari, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehran","family":"Rahimlou","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Kheradmand","sequence":"additional","affiliation":[{"name":"Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, Maryland"},{"name":"Department of Neuroscience, Johns Hopkins 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