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Bell's Palsy treatment algorithm (facial nerve paralysis treatment)

last modified on: Thu, 01/11/2018 - 11:18

Bell's Palsy treatment algorithm

return to: Otology - Neurotology

In patients with Bell's Palsy (facial weakness), return to normal facial nerve function (HB I) occurred in the following % of patients:

  •     Those treated with Prednisone/Acyclovir: 93% of patients 
  •     Those treated with placebo:         80% of patients

NOTE:  Acyclovir did not increase chances of facial nerve recovery

(Sullivan, FM. et. al, N Engl J Med. 2007 Oct 18;357(16):1598-607)

In patients with NO PERCEPTIBLE movement within 14 days of onset:

If ENOG degeneration is <90%, ALL patients returned to HB I or II at 7 months (treated with high dose prednisone)

If ENOG degeneration is >90%, and no voluntary EMG response the facial nerve function outcomes at 7 months were:

     without MCF facial nerve decompression: 58% developed poor outcome (HB III or IV); None returned to HB I

     WITH MCF facial nerve decompression: 91% returned to normal or near normal (HB I or II)

HB= House-Brackmann score


Gantz, B, Rubinstein, JT, Gidley, P, Woodworth, GG. Surgical management of Bell's palsy. Laryngoscope 1999;109:1177--88 

Rodenez C, Bernat I, Willer JC, Barre P, Lamas G and Tankere F: J Laryngol otol. 2010 Mar; 124(3):272-8