Bell’s Palsy management

Treatment directed at the facial nerve has been a controversial area for many years, but recent high quality studies have clearly established the benefits of steroids in Bell’s palsy.


Two recent large, high quality studies [12,13], and subsequent systematic reviews and meta-analyses [14,15], have all shown a reduction in time to complete recovery and an increased chance of complete recovery at three and nine months in patients treated with steroids (NNT 6 (95% CI, 4 to 9) for complete recovery at three months).

Both studies were restricted to patients with Bell’s palsy who presented within 72 hours; and in both studies they used prednisolone at a dose of 50 mg or 60 mg for a total of 10 days; one of the studies tapering the dose after 5 days [12,13].

Subgroup analysis from both systematic reviews and meta-analysis suggests that steroids may also be associated with improved recovery, even when started more than three days after the onset of symptoms [15].

NICE Recommends for people presenting within 72 hours of the onset of symptoms, consider prescribing prednisolone

• Giving 50 mg daily for 10 days or
• Giving 60 mg daily for five days followed by a daily reduction in dose of 10 mg (for a total treatment time of 10 days) if a reducing dose is preferred.

Learning bite

Treatment of patients with Bell’s palsy with corticosteroids has been proved to have beneficial effects on recovery time and to increase the chances of a complete recovery.

Antiviral agents

The effects of antiviral agents on recovery were also studied in the previously mentioned trials and further systematic reviews.

No positive benefit was demonstrated with the use of antiviral agents either used alone or in combination with prednisolone.

A meta-analysis directly comparing the use of steroids, with and without antiviral agents, confirmed this conclusion [16].

Learning bite

The addition of an antiviral agent to steroid treatment in Bell’s palsy has not been shown to provide any additional benefit.