What is the treatment for Bell's (Idiopathic Facial) palsy?

From the Guidelines

Bell's palsy treatment should involve corticosteroids as the primary therapy, with oral steroids prescribed within 72 hours of symptom onset for patients 16 years and older, as this has been shown to improve outcomes by reducing inflammation of the facial nerve 1.

Key Components of Treatment

• Corticosteroids: prednisone 60-80mg daily for 7 days, then tapered over the next 3 days, started within 72 hours of symptom onset
• Antiviral medications: may be added, especially if herpes infection is suspected, such as valacyclovir 1000mg three times daily for 7 days
• Eye protection: artificial tears during the day and lubricating eye ointment at night, plus taping the eye closed if unable to close it completely
• Physical therapy: facial exercises and massage can help maintain muscle tone
• Pain management: acetaminophen or NSAIDs may be used

Important Considerations

• Most patients recover fully within 3-6 months without treatment, but early corticosteroid therapy improves outcomes
• If no improvement occurs after 3 months or symptoms worsen, further evaluation is needed to rule out other conditions
• Psychological support is also important as facial paralysis can cause significant emotional distress

Evidence-Based Recommendations

• Clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell’s palsy patients 16 years and older 1
• Clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell’s palsy 1
• Clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure 1

From the Research

Treatment Options for Bell's Palsy

• Corticosteroids are the mainstay of treatment for Bell's palsy and should be initiated within 72 hours of symptom onset 2
• Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making 2, 3
• The combination of antivirals and corticosteroids has been shown to reduce the rate of incomplete recovery and sequelae of Bell's palsy compared to corticosteroids alone 3
• High-dose corticosteroids (≥80 mg) may be more effective than standard-dose corticosteroids (40-60 mg) in the treatment of Bell's palsy, with a significant decrease in nonrecovery at 6 months follow-up 4

Comparison of Treatment Modalities

• A study comparing acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy found that the overall recovery rate of patients treated with steroid and acyclovir was greater than that of patients treated with steroid alone, but the difference was not statistically significant 5
• A retrospective analysis of 1504 patients with Bell's palsy found that recovery rates were highest in patients who received steroid monotherapy initiated within 72 hours, and that patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 hours 6

Factors Affecting Recovery

• Age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions may affect recovery rates in patients with Bell's palsy 6
• Patients aged 20 to 39 years had a higher recovery rate than other age groups, and fairly predictive EMG results were associated with significantly higher recovery rates 6