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
- Treatment must be initiated within 72 hours of symptom onset to be effective 1, 2, 3
- Strong evidence supports corticosteroid use, with studies showing 83% recovery at 3 months with prednisolone vs 63.6% with placebo 3, 4
- The number needed to treat (NNT) to achieve one additional complete recovery is 6 4
Eye Protection
- 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 Therapy
- Antiviral therapy alone should NOT be prescribed as it is ineffective 1, 2, 3
- Combination therapy with oral antivirals and corticosteroids may be considered as an option within 72 hours of symptom onset 2, 3
- Some evidence suggests slightly higher complete recovery rates with combination therapy (96.5%) compared to steroids alone (89.7%) 2
Special Populations
- Children have better prognosis with higher rates of spontaneous recovery than adults 1, 3
- For pregnant women, treatment with oral corticosteroids should be considered with careful assessment of benefits and risks 1, 3
Follow-up and Monitoring
- Reassess or refer to a facial nerve specialist if: 1, 2, 3
- New or worsening neurologic findings develop
- Ocular symptoms develop
- Incomplete facial recovery persists 3 months after initial symptom onset
Recovery Timeline
- 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
- Most patients begin showing signs of recovery within 2-3 weeks of 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, 5
- Using antiviral therapy alone is ineffective and not recommended 1, 2, 6
- 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
- Routine laboratory testing and imaging are not required for typical presentations of Bell's palsy 3, 6