What is the immediate treatment for a patient with Bell's palsy?

Immediate Treatment for Bell's Palsy

Oral corticosteroids should be prescribed within 72 hours of symptom onset for all patients 16 years and older with Bell's palsy. 1, 2, 3

First-Line Treatment

• Prescribe oral corticosteroids using one of these regimens:
  • Prednisolone 50 mg daily for 10 days 1, 2, 3
  • OR Prednisone 60 mg daily for 5 days followed by a 5-day taper 1, 2, 3, 4
• Treatment must be initiated within 72 hours of symptom onset for maximum effectiveness 1, 2, 3
• Strong evidence supports corticosteroid use, with studies showing 83% recovery at 3 months with prednisolone vs 63.6% with placebo 3

Eye Protection (Critical)

• Implement eye protection for all patients with impaired eye closure to prevent corneal damage 1, 3
• Use lubricating ophthalmic drops for daytime protection 1, 3
• Apply ophthalmic ointments for nighttime protection 1, 3
• Consider moisture chambers, eye patching/taping, and sunglasses as appropriate 1, 3

Antiviral Considerations

• Antiviral therapy alone should NOT be prescribed (ineffective) 1, 2, 3, 4
• Combination therapy with oral antivirals and corticosteroids may be considered as an option within 72 hours of symptom onset 2, 3
• Some evidence shows higher complete recovery rates with combination therapy (96.5%) compared to steroids alone (89.7%) 2, 5

Special Populations

• Children: Have better prognosis with higher spontaneous recovery rates than adults; evidence for steroid use is less conclusive 1, 3, 6
• Pregnant women: Treat with oral corticosteroids within 72 hours with careful assessment of benefits and risks 3

Follow-up Recommendations

• Monitor for recovery; most patients begin showing signs within 2-3 weeks 1, 3
• Reassess or refer to a facial nerve specialist if:
  • New or worsening neurologic findings develop 1, 3
  • Ocular symptoms develop 1, 3
  • Incomplete facial recovery persists 3 months after initial symptom onset 1, 3

Common Pitfalls to Avoid

• Starting steroid treatment beyond the 72-hour window provides minimal benefit and exposes patients to medication risks 1, 2, 3
• Using antiviral therapy alone is ineffective and not recommended 1, 2, 3
• Failing to provide adequate eye protection for patients with impaired eye closure can lead to corneal damage 1, 3
• Not referring patients with incomplete recovery after 3 months for specialist evaluation 1, 3

Prognosis

• Approximately 70% of patients with complete paralysis recover facial function completely within 6 months even without treatment 1, 3
• Patients with incomplete paralysis have higher recovery rates, up to 94% 1, 3
• Complete recovery typically occurs within 3-4 months for most patients 3