From the Guidelines
Bell's Palsy treatment should involve prescribing oral steroids within 72 hours of symptom onset for patients 16 years and older, as this has been shown to significantly improve facial nerve function and reduce the risk of long-term facial weakness 1.
Treatment Overview
The treatment of Bell's Palsy typically involves a combination of corticosteroids and sometimes antiviral medications started within 72 hours of symptom onset.
- Prednisone is the most commonly prescribed corticosteroid, usually given at a dose that can be tapered over a period of time.
- For patients with severe symptoms or those seen very early, adding an antiviral like valacyclovir may provide additional benefit, especially if herpes virus infection is suspected 1.
Eye Protection and Physical Therapy
Eye protection is crucial for patients with impaired eye closure, using artificial tears during the day and lubricating eye ointment at night, and taping the eyelid closed while sleeping if unable to close it completely 1.
- Physical therapy with facial exercises and massage may help maintain muscle tone during recovery, although the evidence for this is not as strong.
Importance of Early Treatment
Most patients recover completely within 3-6 months without treatment, but early corticosteroid therapy increases the chance of complete recovery and reduces the risk of long-term facial weakness 1.
- Corticosteroids work by reducing inflammation of the facial nerve within the narrow facial canal, while antivirals may help if the cause is viral reactivation.
Patient Follow-up
Clinicians should reassess or refer to a facial nerve specialist those Bell's Palsy patients with new or worsening neurologic findings, ocular symptoms, or incomplete facial recovery 3 months after initial symptom onset 1.
From the Research
Treatment Options for Bell's Palsy
- Corticosteroids are widely used in the treatment of Bell's palsy and have been shown to be effective in reducing the risk of unsatisfactory recovery 2, 3.
- Antiviral agents, when used alone, have not been shown to be effective in reducing the risk of unsatisfactory recovery 2, 4, 5.
- The combination of corticosteroids and antiviral agents may be associated with additional benefit compared to corticosteroids alone 2, 4, 3.
- The timing of treatment initiation is also important, with earlier treatment (within 72 hours) associated with better outcomes 6.
Efficacy of Treatment Options
- Corticosteroids have been shown to be effective in reducing the risk of unsatisfactory recovery, with a relative risk of 0.69 (95% CI, 0.55-0.87) 2.
- The combination of corticosteroids and antiviral agents has been shown to be associated with a reduced risk of unsatisfactory recovery, with a relative risk of 0.48 (95% CI, 0.29-0.79) 3.
- Antiviral agents alone have not been shown to be effective in reducing the risk of unsatisfactory recovery, with a relative risk of 1.14 (95% CI, 0.80-1.62) 3.