From the Guidelines
The recommended treatment duration for Bell's palsy is typically 7-10 days of oral corticosteroids, preferably started within 72 hours of symptom onset. The standard regimen is prednisolone 60-80mg daily for 5-7 days, followed by a taper over the next 3-5 days, as supported by high-quality randomized controlled trials such as the study by Sullivan et al 1. This treatment approach has been shown to significantly improve facial nerve function and reduce the risk of long-term sequelae. Antiviral medications like valacyclovir (1000mg three times daily for 7 days) may be added in severe cases, though evidence for their benefit is less robust than for steroids alone, as noted in the guideline by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Key Considerations
- Eye protection is crucial during treatment, including artificial tears during the day, lubricating ointment at night, and possibly taping the eyelid closed to prevent corneal damage, as emphasized in the clinical practice guideline 1.
- Physical therapy with facial exercises and massage may be beneficial during recovery, which typically takes 3-6 months for most patients.
- Treatment aims to reduce inflammation of the facial nerve within the facial canal, thereby improving blood flow and preventing nerve degeneration.
- Most patients (about 70-85%) recover completely with appropriate and timely treatment, though some may have residual weakness, as reported in the study by Sullivan et al 1.
Treatment Overview
- The use of oral steroids within 72 hours of symptom onset is a strong recommendation based on high-quality evidence 1.
- The role of patient preference in making decisions deserves further clarification, and clinicians should provide patients with clear and comprehensible information on the benefits to facilitate patient understanding and shared decision making 1.
From the Research
Treatment Duration for Bell's Palsy
The recommended treatment duration for Bell's palsy varies depending on the treatment approach.
- For oral corticosteroid regimens, a common treatment duration is 5 to 10 days, with a tapering dose 2, 3.
- Antiviral therapy, when used in combination with corticosteroids, is typically administered for 7 to 10 days 2, 4.
- Physical therapy may be beneficial for patients with more severe paralysis, but the optimal duration of physical therapy is not well established 2, 3.
Corticosteroid Treatment Duration
- A study comparing high-dose to standard-dose corticosteroids for the treatment of Bell's palsy found that high-dose corticosteroids (≥80 mg) may be more effective than standard-dose corticosteroids (40-60 mg) in reducing non-recovery rates at 6 months follow-up 5.
- Another study found that initiating corticosteroid treatment within 72 hours of symptom onset was associated with higher recovery rates, and that treatment duration may be flexible depending on patient behavior patterns and individual factors 6.
Antiviral Treatment Duration
- A systematic review and meta-analysis found that adding antivirals to corticosteroids may reduce the rate of incomplete recovery and long-term sequelae in patients with Bell's palsy, but the optimal duration of antiviral therapy is not well established 4.
- The review found that antiviral therapy alone was not effective in treating Bell's palsy, and that corticosteroids alone were more effective than antivirals alone 4.