What is the recommended treatment for Bell's palsy?

Bell's Palsy Treatment

Oral corticosteroids are strongly recommended as the primary treatment for Bell's palsy and should be initiated within 72 hours of symptom onset. 1

First-Line Treatment

• Corticosteroid therapy:
  • Prednisone 50-60 mg daily for 5 days followed by a 5-day taper 2
  • Should be started within 72 hours of symptom onset for maximum benefit 1
  • High-quality evidence shows significantly improved recovery rates with early steroid administration 1
  • Treatment with prednisolone increases complete recovery rates from 63.6% to 83.0% at 3 months and from 81.6% to 94.4% at 9 months 3

Antiviral Therapy

• Optional adjunctive treatment:
  • May be considered in combination with steroids, especially in severe cases 1
  • Options include:
    • Valacyclovir 1 g three times daily for 7 days 2
    • Acyclovir 400 mg five times daily for 10 days 2
  • Evidence shows minimal additional benefit when combined with steroids (RR 0.75,95% CI 0.56-1.00) 1
  • Antiviral therapy alone is ineffective and not recommended 2, 3

Eye Protection

• Critical component of management:
  • Strongly recommended for patients with impaired eye closure 1
  • Measures include:
    • Artificial tears during the day
    • Ocular ointment at night
    • Eye patching or taping if needed
  • Prevents corneal damage, which can lead to permanent vision impairment 1

Special Populations

• Elderly patients:

  • May benefit more significantly from combination therapy (corticosteroids plus antivirals) 4
  • One study showed 100% recovery in treated elderly patients versus only 41.7% in untreated controls 4

• Pregnant women and children:

  • Generally have better prognosis (up to 90% complete spontaneous recovery) 2
  • Treatment decisions should consider risks and benefits of medications during pregnancy

Adjunctive Therapies

• Physical therapy:
  • May be beneficial for patients with more severe paralysis 1, 2
  • Can include facial exercises, massage, and biofeedback training 5
  • Helps maintain range of motion and prevent contractures 1

Follow-up and Monitoring

• Reevaluation is necessary if:

  • New or worsening neurologic findings develop
  • Incomplete recovery after 3 months 1

• For persistent Bell's palsy:

  • Consider reconstructive procedures (eyelid weights, brow lifts, facial slings) 1

Common Pitfalls to Avoid

1. Delayed treatment: Initiating steroids after 72 hours significantly reduces effectiveness 1
2. Using antivirals alone: Not supported by evidence and ineffective 2, 3
3. Neglecting eye protection: Can lead to permanent corneal damage 1
4. Misdiagnosis: Bell's palsy is a diagnosis of exclusion; bilateral facial weakness is rare and should prompt investigation for other causes 1
5. Overlooking psychological impact: Addressing emotional needs of patients is important 1

While 70-94% of patients recover completely without treatment, early intervention with corticosteroids significantly improves outcomes and reduces the risk of permanent facial weakness 1.