What is the treatment for Bell's palsy?

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

First-Line Treatment

• The recommended corticosteroid regimen is either:

  • Prednisolone 50 mg daily for 10 days, OR
  • Prednisone 60 mg daily for 5 days followed by a 5-day taper 1, 2

• Corticosteroids significantly improve outcomes, with studies showing 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 2

• Treatment must be initiated within 72 hours of symptom onset to be effective; benefits after this window are less clear 3

Antiviral Therapy Considerations

• Antiviral monotherapy should NOT be prescribed for Bell's palsy as it is ineffective 1, 2

• Combination therapy with oral antivirals plus corticosteroids may be considered within 72 hours of symptom onset 1

  • Some evidence shows higher complete recovery rates with combination therapy (96.5%) compared to steroids alone (89.7%) 1
  • Recommended antivirals include valacyclovir (1 g three times daily for 7 days) or acyclovir (400 mg five times daily for 10 days) 4

Eye Protection (Critical Component)

• Implement eye protection for all patients with impaired eye closure to prevent corneal damage 1, 2
  • Use lubricating ophthalmic drops frequently throughout the day 2
  • Apply ophthalmic ointments, particularly at night 2
  • Consider moisture chambers, eye patching/taping with proper technique, and sunglasses for outdoor protection 2

Special Populations

• Children have higher rates of spontaneous recovery than adults (up to 90%), and evidence for steroid use in children is less conclusive 1, 2, 4

• For pregnant women, oral corticosteroids should still be considered within 72 hours of symptom onset, with individualized assessment of benefits and risks 2

Follow-up and Monitoring

• Reassess or refer to a facial nerve specialist if:

  • New or worsening neurologic findings develop at any point 1, 2
  • Ocular symptoms develop at any point 1, 2
  • Incomplete facial recovery persists 3 months after initial symptom onset 1, 2

• MRI with and without contrast is the imaging test of choice when indicated (for atypical presentations, no recovery after 3 months, or worsening symptoms) 2

Recovery Expectations

• Approximately 70% of patients with complete paralysis recover facial function completely within 6 months 2
• Patients with incomplete paralysis have higher recovery rates, up to 94% 2
• Most patients begin showing signs of recovery within 2-3 weeks of symptom onset 2

Common Pitfalls to Avoid

• Delaying treatment beyond 72 hours reduces effectiveness of therapy 1, 3
• Using antiviral therapy alone is ineffective and not recommended 1, 2
• Failing to provide adequate eye protection for patients with impaired eye closure 1, 2
• Not referring patients with incomplete recovery after 3 months for specialist evaluation 2
• Failing to rule out other causes of facial weakness before diagnosing Bell's palsy 1, 2