Should we check for Hepatitis B surface antigen (HBsAg) and Hepatitis C virus (HCV) when treating Bell's palsy?

Testing for HBsAg and HCV in Bell's Palsy Treatment

Routine laboratory testing, including HBsAg and HCV screening, is NOT recommended for patients with new-onset Bell's palsy. 1

Diagnostic Approach for Bell's Palsy

• Bell's palsy is a diagnosis of exclusion characterized by acute onset (<72 hours) of unilateral facial weakness or paralysis without an identifiable cause 2, 3
• Diagnosis should be based on thorough history and physical examination to exclude other identifiable causes of facial paresis/paralysis 1, 3
• The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against routine laboratory testing in patients with typical presentations of Bell's palsy 1

Evidence Against Routine HBsAg and HCV Testing

• The clinical practice guideline from the American Academy of Otolaryngology-Head and Neck Surgery specifically states: "Clinicians should not obtain routine laboratory testing in patients with new-onset Bell's palsy" 1
• This recommendation against laboratory testing is classified as a "Recommendation (against)" with a preponderance of benefit over harm 1
• There is no evidence supporting a connection between Bell's palsy and hepatitis B or C that would warrant routine screening 2, 4

When Laboratory Testing Might Be Considered

• Laboratory testing should only be considered when specific clinical features suggest an alternative diagnosis 3
• Red flags that might warrant further investigation include:
  • Advanced age (increased stroke risk) 3
  • Bilateral facial weakness (rare in Bell's palsy) 3
  • New or worsening neurologic findings 1, 3
  • Slow progression of symptoms (>72 hours) suggesting neoplastic or infectious cause 3

Treatment Recommendations for Bell's Palsy

• The primary evidence-based treatment for Bell's palsy is oral corticosteroids within 72 hours of symptom onset 1, 2
• Recommended regimen: prednisolone 50 mg daily for 10 days OR prednisone 60 mg daily for 5 days followed by a 5-day taper 2, 5
• Antiviral therapy alone should NOT be prescribed, but may be offered in combination with oral steroids 1, 2
• Eye protection is essential for patients with impaired eye closure 1, 2

Special Considerations

• In patients receiving immunotherapy for cancer, screening for hepatitis B and C is recommended before starting treatment, but this is specific to immunotherapy and not related to Bell's palsy management 1
• For patients with Bell's palsy who happen to have known hepatitis B or C, there are no specific modifications to Bell's palsy treatment required 2, 4

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, 2
  • Ocular symptoms developing at any point 1, 2
  • Incomplete facial recovery 3 months after initial symptom onset 1, 2

In conclusion, based on current clinical practice guidelines, there is no recommendation to check HBsAg and HCV when treating Bell's palsy. The diagnosis should be made clinically, and treatment should focus on timely administration of corticosteroids and appropriate eye protection.