Bell's Palsy

Key points

• 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.
• 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
• Give PREDNISOLONE within 72 HOURS of symptom onset — this time window is the key point. NICE dosing: prednisolone 50 mg daily for 10 days, OR 60 mg daily for 5 days then reducing by 10 mg daily (10 days in total) if a reducing course is preferred.
• EYE CARE IS ESSENTIAL and is the sight-threatening omission: if eyelid closure is incomplete, give artificial tears during the day and lubricating ointment plus taping the eye shut at night · refer urgently to ophthalmology if there is eye pain or any concern about the cornea.
• Antivirals are NOT recommended as monotherapy and add no clear benefit to prednisolone in Bell's palsy · if there is a vesicular rash or severe ear pain, consider RAMSAY HUNT SYNDROME (varicella zoster), which is treated with an antiviral AND a steroid. Management