Prednisone Dosing for Bell's Palsy
The recommended dose of prednisone for Bell's palsy is 60-80mg daily for 7 days with a taper, started within 72 hours of symptom onset. 1
Evidence-Based Dosing Recommendations
The American Academy of Otolaryngology-Head and Neck Surgery strongly recommends oral corticosteroids as first-line treatment for Bell's palsy, with high-quality evidence showing improvement in recovery rates from 70% to 94% when started early 1. Specific dosing regimens supported by evidence include:
- Primary recommendation: Prednisone 60-80mg daily for 7 days with taper 1
- Alternative regimen: Prednisone 50-60mg daily for 5 days followed by a 5-day taper 2
Timing Considerations
Treatment timing significantly impacts efficacy:
- Treatment should be initiated within 72 hours of symptom onset 1
- Patients treated with prednisolone within 48 hours have significantly higher complete recovery rates compared to those treated later 3:
- Within 24 hours: 66% complete recovery (vs. 51% without prednisolone)
- 25-48 hours: 76% complete recovery (vs. 58% without prednisolone)
- 49-72 hours: No significant difference in recovery rates 3
Age-Related Considerations
- Patients aged 40 years or older show significantly higher complete recovery rates when treated with prednisolone 3
- Younger patients (<40 years) experience significantly less synkinesis (involuntary facial movements) when treated with prednisolone, though overall recovery rates are similar with or without treatment 3
- For children, evidence is less conclusive - a recent randomized controlled trial did not demonstrate significant benefit of prednisolone for complete recovery at 1 month 4
Contraindications and Cautions
Corticosteroid therapy should be used cautiously or avoided in patients with:
- Diabetes
- Morbid obesity
- Previous steroid intolerance 1
Combination Therapy
- Antiviral therapy (valacyclovir or acyclovir) may be offered as an optional addition to steroid therapy 1
- Evidence for benefit of combined therapy is mixed, with some studies showing minimal additional benefit when combined with steroids 1
- Treatment with antivirals alone is ineffective and not recommended 2
Follow-up and Referral
- Patients should be reassessed if incomplete facial recovery occurs after 3 months 1
- Referral to a facial nerve specialist is indicated for patients with:
- New or worsening neurologic findings
- Ocular symptoms
- Incomplete facial recovery after 3 months 1
Monitoring Recovery
The House-Brackmann scale is recommended to quantify facial nerve function and monitor recovery:
- Grade 1: Normal facial function
- Grade 2: Mild dysfunction
- Grade 3: Moderate dysfunction
- Grade 4: Moderately severe dysfunction
- Grade 5: Severe dysfunction
- Grade 6: Total paralysis 1