From the Guidelines
The efficacy of initiating corticosteroids after 12 days of onset of Bell's palsy is limited, and it is generally not recommended. For Bell's palsy, oral corticosteroids (such as prednisone) should ideally be started within 72 hours of symptom onset, as supported by high-quality randomized controlled trials, including the study by Sullivan et al 1, which reported significant improvement of facial nerve function in patients treated with prednisolone within 72 hours of onset. The typical regimen is prednisone 60 mg daily for 5 days, followed by a taper over the next 5 days (50 mg, 40 mg, 30 mg, 20 mg, 10 mg).
If a patient presents after 12 days, the potential benefits of steroid treatment are significantly reduced, as the inflammation and swelling of the facial nerve, which steroids aim to reduce, have likely already caused any potential damage by this point. However, if the patient has ongoing symptoms and no contraindications to steroid use, some clinicians might still consider a short course of steroids, but with the understanding that the expected benefit is much lower than with early treatment, as noted in the clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery 1.
The rationale for early steroid use is to reduce inflammation and edema of the facial nerve within its bony canal, potentially preventing compression and subsequent damage. After 12 days, this acute inflammatory phase has likely passed, reducing the potential benefit of steroid therapy. Key points to consider include:
- The importance of early treatment with corticosteroids within 72 hours of symptom onset
- The reduced potential benefits of steroid treatment after 12 days
- The need for individualized decision-making based on patient symptoms and contraindications to steroid use
- The recommendation for a short course of steroids, if used, with a tapering regimen to minimize side effects.
From the Research
Efficacy of Initiating Corticosteroids after 12 Days of Onset of Bell's Palsy
- The provided studies do not directly address the efficacy of initiating corticosteroids after 12 days of onset of Bell's palsy 2, 3, 4, 5, 6.
- Most studies emphasize the importance of early treatment with corticosteroids, typically within 72 hours of symptom onset, to improve recovery rates in Bell's palsy patients 2, 3, 5.
- One study suggests that initiating treatment beyond 72 hours may still be associated with a higher recovery rate than starting treatment within 72 hours, but this finding should be considered with caution due to the limitations of retrospective analysis 5.
- There is no clear evidence to support the efficacy of initiating corticosteroids after 12 days of onset, as the majority of studies focus on early treatment initiation 2, 3, 4, 5, 6.