From the Guidelines
The recommended management for Bell's palsy includes early treatment with oral corticosteroids, typically prednisone 60-80mg daily for 7-10 days, started within 72 hours of symptom onset, as strongly recommended by 1 and 1. This approach is based on high-quality randomized controlled trials that demonstrate a significant improvement in facial nerve function with steroid treatment. The use of antiviral therapy, such as valacyclovir or acyclovir, may be considered in addition to steroids, especially in cases with severe paralysis, although the evidence for antivirals is less robust than for steroids, as noted in 1 and 1. Eye protection is crucial to prevent corneal damage, and patients should be educated on strategies for eye closure and moisturization, such as using artificial tears during the day and eye ointment with taping the eye closed at night, as recommended in 1. Physical therapy with facial exercises and massage may help maintain muscle tone and prevent contractures. Patients should be reassured that approximately 70-85% will experience complete recovery within 3-6 months without treatment, though this improves to about 90% with proper corticosteroid therapy, as reported in 1. If no improvement occurs within 3 months or symptoms worsen, further investigation with imaging and specialist referral is warranted to rule out other causes. Some key points to consider in the management of Bell's palsy include:
- Early treatment with oral corticosteroids within 72 hours of symptom onset
- Consideration of antiviral therapy in addition to steroids, especially in severe cases
- Eye protection to prevent corneal damage
- Physical therapy to maintain muscle tone and prevent contractures
- Patient education and reassurance regarding the prognosis and potential for recovery
- Further investigation and specialist referral if no improvement occurs or symptoms worsen.
From the Research
Management of Bell's Palsy
The management of Bell's palsy typically involves the use of corticosteroids, with or without antivirals. The following are some key points to consider:
- Corticosteroids are the primary treatment choice for Bell's palsy, as they improve outcomes 2, 3, 4, 5.
- High-dose corticosteroids (≥80 mg daily) may be more effective than standard-dose corticosteroids (40-60 mg daily) in reducing non-recovery rates at 6 months 2, 4, 5.
- The use of antivirals is not currently recommended, as there is no evidence to support their effectiveness in treating Bell's palsy 2, 3.
- Intravenous methylprednisolone may be more effective than oral prednisolone in achieving complete recovery to grade 1 in 1 month, particularly for patients with grade 4 Bell's palsy 6.
- Treatment should be started within 3 days of symptom onset for optimal effectiveness 4, 6.
Treatment Options
Some treatment options for Bell's palsy include:
- Oral corticosteroids (40-60 mg daily) 2, 3, 4, 5
- High-dose corticosteroids (≥80 mg daily) 2, 4, 5
- Intravenous methylprednisolone 6
- Antivirals (not currently recommended) 2, 3
- Acupuncture, physical therapy, and chiropractic care may also be considered, although their effectiveness is not well established 3
Important Considerations
Some important considerations in the management of Bell's palsy include:
- Early treatment (within 3 days of symptom onset) is crucial for optimal effectiveness 4, 6.
- High-dose corticosteroids may be more effective for severe Bell's palsy patients, but may not be necessary for moderate cases 4.
- The use of antivirals is not currently recommended, and their effectiveness is not well established 2, 3.