The Lived Experience of Facial Paralysis: Impact of Etiology on Patient Perceptions.

Abstract

To evaluate how patient-reported outcomes vary by etiology of facial paralysis and to identify functional, esthetic, and psychosocial determinants of patient lived experience. Cross-sectional study. Single-center, tertiary academic facial nerve clinic. Adults with inflammatory, schwannoma, parotid neoplasm, or congenital facial paralysis completed FACE-Q modules, the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), and a social support rating. Facial paralysis severity was graded with Sunnybrook scores. Kruskal-Wallis and Dunn's post hoc testing along with multivariable linear regression assessed associations between etiology and outcomes, adjusting for severity, duration, prior surgical procedures, emotional intelligence, and social support. Etiology independently shaped patient experience in multiple domains. Compared with inflammatory paralysis, parotid neoplasm was associated with worse lip appearance (β = -12.07, SE = 5.05, P = .036), speech function (β = -16.16, SE = 6.40, P = .010), and speech-related distress (β = -5.51, SE = 2.11, P = .009). Congenital paralysis was linked to lower appearance distress (β = 12.81, SE = 5.30, P = .017) and higher social functioning (β = 17.48, SE = 7.13, P = .028). Schwannoma resection had improved facial appearance (β = 7.96, SE = 3.03, P = .020) and psychological function (β = 6.83, SE = 2.89, P = .037). Across etiologies, higher baseline emotional intelligence improved appearance, psychosocial, and functional perceptions, while stronger social support mitigated speech-related distress and outcomes. Patient-reported outcomes and lived experience in facial paralysis differ meaningfully by etiology. Beyond clinical severity, a patient's emotional intelligence, social context, and underlying cause of paralysis shape personal perceptions of appearance, function, and well-being. These findings highlight the importance of etiology-specific counseling, rehabilitation, and psychosocial support to optimize recovery and quality of life.