What is the recommended treatment for Bell's palsy?

Treatment for Bell's Palsy

Oral corticosteroids should be prescribed within 72 hours of symptom onset as the first-line treatment for Bell's palsy in patients 16 years and older. 1, 2, 3

First-Line Treatment

• Prednisolone 50 mg daily for 10 days OR prednisone 60 mg daily for 5 days followed by a 5-day taper is the recommended regimen 2, 3
• Early corticosteroid treatment significantly improves recovery rates (83% at 3 months with prednisolone vs 63.6% with placebo; 94.4% at 9 months with prednisolone vs 81.6% with placebo) 2, 4
• Treatment must be initiated within 72 hours of symptom onset to be effective, as clinical trials demonstrating efficacy specifically enrolled patients within this timeframe 1, 2

Eye Protection Measures

• Implement eye protection for all patients with impaired eye closure to prevent corneal damage 1, 2
• Use lubricating ophthalmic drops frequently throughout the day 1, 2
• Apply ophthalmic ointments for nighttime protection 1, 2
• Consider moisture chambers, eye patching/taping, and sunglasses as appropriate 1, 2
• Refer patients with severe impairment to ophthalmology for evaluation 2

Antiviral Therapy

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

Special Populations

• Children have better prognosis with higher rates of spontaneous recovery than adults 1, 2
• For pregnant women, treatment should be individualized with careful assessment of benefits and risks 1, 2

Follow-up and Monitoring

• Monitor for recovery and consider referral if:
  • New or worsening neurologic findings develop 1, 2
  • Ocular symptoms develop 1, 2
  • Incomplete facial recovery persists 3 months after initial symptom onset 1, 2, 3

Expected Recovery Timeline

• Most patients begin showing signs of recovery within 2-3 weeks of symptom onset 1, 2
• Approximately 70% of patients with complete paralysis recover facial function completely within 6 months even without treatment 1, 2
• Patients with incomplete paralysis have higher recovery rates, up to 94% 1, 2
• Complete recovery typically occurs within 3-4 months for most patients 2

Common Pitfalls to Avoid

• Starting steroid treatment beyond the 72-hour window provides minimal benefit and exposes patients to medication risks 1, 3
• Failing to provide adequate eye protection for patients with impaired eye closure can lead to corneal damage 1, 2
• Using antiviral therapy alone is ineffective and not recommended 1, 2, 3, 5
• Not referring patients with incomplete recovery after 3 months for specialist evaluation 1, 2
• Performing routine laboratory testing and imaging for typical presentations of Bell's palsy is unnecessary 2, 3