A 60-year-old man is diagnosed with Bell's palsy. What is the current evidenced base approach to the management of this condition?


#1

A 60-year-old man is diagnosed with Bell’s palsy. What is the current evidenced base approach to the management of this condition?

Refer for urgent surgical decompression
Aciclovir
No treatment
Aciclovir + prednisolone
Prednisolone

Dr. Kasper:
Prednisolone

Bell’s palsy

Bell’s palsy may be defined as an acute, unilateral, idiopathic, facial nerve paralysis. The aetiology is unknown although the role of the herpes simplex virus has been investigated previously. The peak incidence is 20-40 years and the condition is more common in pregnant women.

Features

lower motor neuron facial nerve palsy - forehead affected*
patients may also notice post-auricular pain (may precede paralysis), altered taste, dry eyes, hyperacusis

Management

in the past a variety of treatment options have been proposed including no treatment, prednisolone only and a combination of aciclovir and prednisolone
following a National Institute for Health randomised controlled trial it is now recommended that prednisolone 1mg/kg for 10 days should be prescribed for patients within 72 hours of onset of Bell’s palsy. Adding in aciclovir gives no additional benefit
eye care is important - prescription of artificial tears and eye lubricants should be considered

Prognosis

if untreated around 15% of patients have permanent moderate to severe weakness

*upper motor neuron lesion ‘spares’ upper face