Association of SARS-CoV-2 Vaccination or Infection With Bell Palsy

<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–infected vs SARS-CoV-2–vaccinated 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 (77 525 vaccine recipients vs 66 682 placebo recipients; odds ratio [OR], 3.00; 95% CI, 1.10-8.18; <jats:italic>I</jats:italic><jats:sup>2</jats:sup> = 0%). There was, however, no significant increase in BP after administration of the messenger RNA SARS-CoV-2 vaccine in pooling 8 observational studies (13 518 026 doses vs 13 510 701 unvaccinated; OR, 0.70; 95% CI, 0.42-1.16; <jats:italic>I</jats:italic><jats:sup>2</jats:sup> = 94%). No significant difference was found in BP among 22 978 880 first-dose recipients of the Pfizer/BioNTech vaccine compared with 22 978 880 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> = 0%). Bell palsy was significantly more common after SARS-CoV-2 infection (n = 2 822 072) than after SARS-CoV-2 vaccinations (n = 37 912 410) (relative risk, 3.23; 95% CI, 1.57-6.62; <jats:italic>I</jats:italic><jats:sup>2</jats:sup> = 95%).</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–vaccinated 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>