What is the inpatient treatment for Bell's palsy?

Inpatient Treatment of Bell's Palsy

Oral corticosteroids within 72 hours of symptom onset are the cornerstone of inpatient treatment for Bell's palsy, with eye protection measures being essential for patients with impaired eye closure. 1, 2

Diagnostic Approach

• Confirm diagnosis through history and physical examination to exclude other causes of facial paralysis
• Bell's palsy is defined as acute unilateral facial nerve paresis or paralysis with onset in <72 hours without identifiable cause
• Routine laboratory testing and diagnostic imaging are not recommended 1, 2

First-Line Treatment

Corticosteroid Therapy

• Prescribe oral steroids within 72 hours of symptom onset (strong recommendation) 1, 2
• Dosing options:
  • Prednisolone 50 mg daily for 10 days 2
  • Prednisone 60 mg daily for 5 days followed by a 5-day taper 2, 3
• Evidence shows significantly improved recovery rates:
  • 83% complete recovery at 3 months with prednisolone vs. 63.6% with placebo 4
  • 94.4% recovery at 9 months with prednisolone vs. 81.6% without 4, 5
• Number needed to treat (NNT) for one additional complete recovery: 6 5

Eye Protection (Critical)

• Implement eye protection for patients with impaired eye closure (strong recommendation) 1
• Measures include:
  • Frequent lubricating eye drops
  • Ophthalmic ointment (especially at night)
  • Moisture chamber or eye taping/patching 2
• Prevents corneal abrasions, exposure keratitis, and ulcerations 1

Optional Additional Therapy

Antiviral Therapy

• May offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset (optional recommendation) 1, 2
• Options include:
  • Valacyclovir 1 g three times daily for 7 days 3
  • Acyclovir 400 mg five times daily for 10 days 3
• Do not prescribe antiviral therapy alone (strong recommendation against) 1, 2
• Evidence shows minimal additional benefit when combined with steroids:
  • Small trend toward additional benefit (RR 0.75,95% CI 0.56-1.00) 2
  • No significant difference in recovery rates between acyclovir and no acyclovir groups (71.2% vs. 75.7%) 4

Special Considerations

Dosing Considerations

• Some evidence suggests high-dose corticosteroids (≥80 mg) may be more effective than standard doses (40-60 mg) with decreased non-recovery at 6 months (OR = 0.17,95% CI = 0.05-0.56) 6
• However, higher-quality evidence supports standard dosing regimens 1, 2, 4

Monitoring and Follow-up

• Monitor for:
  • New or worsening neurologic findings
  • Development of ocular symptoms
  • Incomplete facial recovery after 3 months 1, 2
• Refer to facial nerve specialist if any of the above occur 1, 2

Treatment Efficacy

• 70-94% of patients recover completely without treatment 2
• Early treatment with prednisolone significantly improves complete recovery:
  • At 3 months: 83.0% vs. 63.6% without prednisolone 4
  • At 9 months: 94.4% vs. 81.6% without prednisolone 4
• Early deterioration (within first 11-17 days) is a negative prognostic factor, but prednisolone still improves outcomes in these patients (62% vs. 31% complete recovery) 2

Common Pitfalls to Avoid

• Delaying corticosteroid treatment beyond 72 hours
• Using antiviral therapy alone
• Neglecting eye protection measures
• Failing to refer patients with incomplete recovery after 3 months
• Performing unnecessary diagnostic testing or imaging

Bell's palsy management primarily focuses on early corticosteroid administration and eye protection, with optional addition of antiviral therapy based on shared decision-making with the patient.