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

From the Guidelines

Steroids are the first line treatment for Bell's (Idiopathic Facial) palsy.

Treatment Overview

• The treatment for Bell's palsy is focused on reducing inflammation of the facial nerve, which is the primary cause of the condition.
• According to the American College of Radiology 1, most patients with Bell's palsy experience complete recovery of function by 6 months, and this recovery can be hastened with steroids.

Clinical Presentation and Diagnosis

• Bell's palsy presents with facial droop, pain around the jaw or ear, hyperacusis, tinnitus, reduced taste, and decreased lacrimation or salivation.
• The diagnosis of Bell's palsy is typically made based on clinical presentation, and imaging is not necessary unless the symptoms are atypical, recurrent, or persist for 2 to 4 months 1.

Management

• Steroids are the primary treatment for Bell's palsy, and they have been shown to improve outcomes and hasten recovery 1.
• The use of steroids in the treatment of Bell's palsy is supported by the fact that most cases are attributed to inflammation of the facial nerve, which may be idiopathic or due to herpes simplex virus 1.

From the Research

First Line Treatment for Bell's Palsy

• The first line treatment for Bell's palsy is an oral corticosteroid regimen, such as prednisone, 50 to 60 mg per day for five days followed by a five-day taper 2
• Combination therapy with an oral corticosteroid and antiviral may reduce rates of synkinesis (misdirected regrowth of facial nerve fibers manifesting as involuntary co-contraction of certain facial muscles) 2
• Recommended antivirals include valacyclovir (1 g three times per day for seven days) or acyclovir (400 mg five times per day for 10 days) 2
• Treatment with antivirals alone is ineffective and not recommended 2, 3

Effectiveness of Corticosteroids and Antivirals

• Corticosteroids alone were probably more effective than antivirals alone in treating Bell's palsy 4, 5, 3, 6
• The combination of antivirals and corticosteroids may have little or no effect on rates of incomplete recovery in comparison to corticosteroids alone in Bell's palsy of various degrees of severity 4, 6
• Moderate-quality evidence indicated that the combination of antivirals and corticosteroids reduced sequelae of Bell's palsy compared with corticosteroids alone 5, 6

Adverse Events

• There was no significant increase in adverse events from the use of antivirals compared with either placebo or corticosteroids, based on low-quality to moderate-quality evidence 4, 5, 3, 6