From the Guidelines
The recommended treatment for Bell's palsy is to prescribe oral steroids within 72 hours of symptom onset for patients 16 years and older, as this has been shown to significantly improve outcomes and reduce the risk of permanent nerve damage. This recommendation is based on high-quality randomized controlled trials, such as 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 standard regimen is prednisone 60-80mg daily for 5-7 days, followed by a taper over the next 5-7 days.
Some key points to consider in the treatment of Bell's palsy include:
- Antiviral medications like valacyclovir or acyclovir may be added, especially in cases with severe symptoms, though their benefit is less established than steroids 1.
- Eye protection is crucial for patients who cannot close their affected eye completely, and includes artificial tears during the day, lubricating ointment at night, and possibly taping the eye closed or using an eye patch 1.
- Physical therapy with facial exercises and massage may help maintain muscle tone and prevent contractures, although the evidence for this is not as strong as for corticosteroid therapy 1.
- Most patients with Bell's palsy recover completely within 3-6 months without treatment, but early corticosteroid therapy significantly improves outcomes by reducing inflammation of the facial nerve within the facial canal, which helps prevent permanent nerve damage and improves the chances of complete recovery 1.
It's also important to note that the evidence for the use of steroids in children with Bell's palsy is limited, and the decision to use steroids in this population should be made on a case-by-case basis, taking into account the potential benefits and risks 1. Additionally, further research is needed to fully understand the benefits and risks of different treatment modalities, including combination antiviral therapy, electrodiagnostic testing, and physical therapy 1.
From the Research
Treatment Options for Bell's Palsy
- The primary treatment for Bell's palsy is corticosteroids, which should be initiated within 72 hours of symptom onset 2, 3.
- Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making 2, 4, 5.
- The combination of steroid and antiviral treatment increases the possibility of recovery in moderately severe to complete acute Bell's palsy 4.
- Corticosteroids alone are more effective than antivirals alone, and antivirals plus corticosteroids are more effective than placebo or no treatment 5.
Recommended Treatment Approach
- A thorough history and physical examination are essential for establishing the correct diagnosis of Bell's palsy 2.
- The treatment approach should be based on the severity of the condition, with severe cases requiring more aggressive treatment 5.
- There is no evidence to support the use of acupuncture, physical therapy, electrotherapy, or surgical decompression for the treatment of Bell's palsy 2.
Treatment Outcomes
- Early treatment with prednisolone significantly improves the chances of complete recovery at 3 and 9 months 3.
- The combination of antivirals and corticosteroids reduces sequelae of Bell's palsy compared with corticosteroids alone 5.
- There is no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids 5.