New recommendations on diagnosis and treatment of Bell's palsy

Recommendations on diagnosing and treating Bell's palsy were recently provided by a new clinical practice guideline from the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

The guideline is intended to improve diagnosis, quality of care and outcomes for Bell's palsy patients and decrease harmful variation in the evaluation and management of the condition. In a clinical practice guideline summary, the recommendations were summarized as a list of key action statements:

• Clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute-onset unilateral facial paresis or paralysis.
• Clinicians should not obtain routine laboratory testing in patients with new-onset Bell's palsy.
• Clinicians should not routinely perform diagnostic imaging for patients with new-onset Bell's palsy.
• Clinicians should prescribe oral steroids within 72 hours of symptom onset for Bell's palsy patients 16 years and older.
• Clinicians should not prescribe oral antiviral therapy alone for patients with new-onset Bell's palsy but may offer oral antiviral therapy in addition to oral steroids within 72 hours of symptom onset.
• Clinicians should implement eye protection for Bell's palsy patients with impaired eye closure.
• Clinicians should not perform electrodiagnostic testing in Bell's palsy patients with incomplete facial paralysis but may offer electrodiagnostic testing to those with complete facial paralysis.
• Clinicians should reassess or refer to a facial nerve specialist those Bell's palsy patients with new or worsening neurologic findings at any point, ocular symptoms developing at any point, or incomplete facial recovery 3 months after initial symptom onset.
• No recommendation could be made regarding the effects of surgical decompression, acupuncture or physical therapy for Bell's palsy patients, the guideline concluded.

The recommendations were developed by a panel of otolaryngology–head and neck surgeons, neurologists, facial plastic and reconstructive surgeons, neurotologists, otologists, emergency medicine and primary care professionals, nurses and physician assistants and consumer advocates. The full guideline was published Nov. 4 in Otolaryngology–Head and Neck Surgery.