What is the evidence for physiotherapy or acupuncture in treating Bell's palsy?

Evidence for Physiotherapy and Acupuncture in Bell's Palsy

There is insufficient evidence to recommend either physiotherapy or acupuncture for the treatment of Bell's palsy, as current clinical practice guidelines make no recommendation regarding these interventions due to lack of high-quality evidence.

Current Evidence Status

• The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) clinical practice guidelines explicitly state that no recommendation can be made regarding the effect of acupuncture in Bell's palsy patients due to poor-quality trials and an indeterminate ratio of benefit and harm 1
• Similarly, no recommendation can be made regarding the effect of physical therapy in Bell's palsy patients due to limited evidence consisting only of case series and an equilibrium of benefit and harm 1
• Well-designed studies for both acupuncture and physical therapy are lacking, and available data are of low quality, preventing evidence-based recommendations 2

Established Treatment Recommendations

• The primary evidence-based treatment for Bell's palsy is oral corticosteroids, which should be prescribed within 72 hours of symptom onset for patients 16 years and older 1, 3
• Corticosteroids significantly improve facial nerve recovery, with 83% recovery at 3 months with prednisolone versus 63.6% with placebo, and 94.4% recovery at 9 months with prednisolone versus 81.6% with placebo 3, 4
• The recommended regimen is prednisolone 50 mg daily for 10 days or prednisone 60 mg daily for 5 days followed by a 5-day taper 3

Eye Protection

• Eye protection is strongly recommended for Bell's palsy patients with impaired eye closure to prevent corneal damage 1
• This is a strong recommendation based on expert opinion and clinical rationale with a preponderance of benefit over harm 1

Follow-up Recommendations

• Patients should be reassessed or referred to a facial nerve specialist if they have:
  • New or worsening neurologic findings at any point 1, 3
  • Ocular symptoms developing at any point 1, 3
  • Incomplete facial recovery 3 months after initial symptom onset 1, 3

Special Considerations

• Children with Bell's palsy generally have a better prognosis than adults, with higher rates of spontaneous recovery 3
• The benefit of corticosteroid treatment in children is inconclusive, with a recent randomized controlled trial showing no significant improvement in complete recovery at 1 month with prednisolone compared to placebo (49% vs 57%) 5
• Antiviral therapy alone should not be prescribed for Bell's palsy, but may be offered in combination with oral steroids within 72 hours of symptom onset as an option 1, 3

Conclusion on Physiotherapy and Acupuncture

• Despite their common use in clinical practice, there is currently insufficient evidence to either recommend or discourage the use of physiotherapy or acupuncture for Bell's palsy 1, 2
• More well-designed clinical trials are needed to determine the potential benefits of these interventions in Bell's palsy management 2