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

last modified on: Mon, 08/07/2023 - 16:10

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 (Sullivan et al. 2007):

  • 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

In patients with NO PERCEPTIBLE movement within 14 days of onset (Gantz et al. 1999):

  • 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

Sullivan FM, Swan IR, Donnan PT, Morrison JM, Smith BH, McKinstry B, Davenport RJ, Vale LD, Clarkson JE, Hammersley V, Hayavi S, McAteer A, Stewart K, Daly F. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med. 2007 Oct 18;357(16):1598-607. doi: 10.1056/NEJMoa072006. PMID: 17942873.