Bell's Palsy Treatment Guidelines

Primary Treatment

The American Academy of Otolaryngology-Head and Neck Surgery recommends prescribing oral corticosteroids within 72 hours of symptom onset for all patients 16 years and older with Bell's palsy, with a strong recommendation based on high-quality randomized controlled trials 1, 2
The recommended regimens are Prednisolone 50 mg daily for 10 days or Prednisone 60 mg daily for 5 days followed by a 5-day taper, with 83% recovery at 3 months compared to 63.6% with placebo, and 94.4% recovery at 9 months compared to 81.6% with placebo 1

Consider individualized assessment for patients with diabetes mellitus, morbid obesity, previous steroid intolerance, or pregnancy, requiring careful benefit-risk assessment 1, 2

The American Academy of Otolaryngology-Head and Neck Surgery does not recommend antiviral therapy alone, as it is ineffective as monotherapy, but may offer combination therapy with oral antivirals plus corticosteroids within 72 hours of symptom onset as an option, with some trials suggesting modest improvement 1, 2

Implement aggressive eye protection immediately for all patients with impaired eye closure to prevent corneal damage, with a strong recommendation based on expert opinion with a preponderance of benefit over harm 1, 2
The eye protection protocol includes lubricating ophthalmic drops every 1-2 hours while awake, ophthalmic ointment at bedtime, eye patching or taping at night, sunglasses for outdoor protection, and moisture chambers using polyethylene covers for severe cases 1

Children have better prognosis than adults, with spontaneous recovery rates up to 90%, but the evidence for corticosteroid benefit in children is inconclusive, and may consider oral corticosteroids in children on a case-by-case basis with substantial caregiver involvement in decision-making 1

Mandatory reassessment or specialist referral is required for incomplete facial recovery at 3 months after symptom onset, new or worsening neurologic findings, or development of ocular symptoms at any point 1
The expected recovery timeline is most patients beginning to show recovery within 2-3 weeks, complete recovery typically occurring within 3-4 months, and approximately 70% of patients with complete paralysis recovering fully within 6 months 1

The American Academy of Otolaryngology-Head and Neck Surgery does not recommend antiviral monotherapy, surgical decompression, acupuncture, or physical therapy, due to ineffectiveness, rare indication, or poor-quality trials 1, 2

Delaying treatment beyond 72 hours reduces effectiveness of corticosteroid therapy, using antiviral therapy alone is ineffective, inadequate eye protection can lead to permanent corneal damage, failing to refer at 3 months for incomplete recovery delays access to reconstructive options, missing atypical features requires imaging and specialist evaluation, and improper eye taping technique can cause corneal abrasion 1, 2