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bells palsy treatment

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"Bell Palsy" AND corticosteroids

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Bell's palsy treatment corticosteroids within 72 hours guideline

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PMID: 39724817

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https://cks.nice.org.uk/topics/bells-palsy/management/manage…

Bell's palsy needs urgent clinical assessment today, especially if symptoms started within the last 72 hours, because treatment works best early.

Usual treatment for adults

  1. Oral corticosteroid
    • A clinician commonly prescribes prednisolone/prednisone as soon as possible, ideally within 72 hours.
    • A commonly used regimen is prednisolone 60 mg daily for 5 days, then tapered over 5 days, but dosing must be individualized, particularly with diabetes, pregnancy, stomach ulcers, glaucoma, infection, or immunosuppression.
    • Steroids are the main treatment and improve the chance of complete facial recovery. Cummings Otolaryngology Head and Neck Surgery, management section, lines 634-640.
  2. Eye protection, especially if the eyelid will not close
    • Preservative-free artificial tears frequently during the day.
    • Lubricating ointment at night.
    • Tape the eyelid closed for sleep or use a protective eye shield.
    • Same-day eye assessment if eye pain, redness, light sensitivity, blurred vision, or a visible dry spot occurs. Lack of eyelid closure can injure the cornea.
  3. Antiviral medication
    • Antivirals such as valaciclovir may sometimes be added, especially with severe weakness or suspected shingles/Ramsay Hunt syndrome.
    • They should not be used alone instead of steroids.
    • Benefit in routine Bell's palsy is uncertain or modest. A 2025 meta-analysis of 10 RCTs found higher recovery with steroid plus antiviral therapy than steroid alone, though the trials were substantially heterogeneous (PMID 39724817).
  4. Supportive care
    • Pain relief such as paracetamol or ibuprofen if safe for you.
    • Gentle facial movement/exercises may be considered later if recovery is delayed, usually with a physiotherapist or facial-nerve specialist. Surgery is not routine.

Get emergency help now if

Facial droop occurs with arm or leg weakness, numbness, speech difficulty, severe headache, confusion, imbalance, or vision loss. These can indicate a stroke rather than Bell's palsy. The NHS stroke warning signs advise emergency assessment in this setting.
Also seek prompt review for:
  • A blistering rash in or around the ear, severe ear pain, vertigo, or hearing loss, which may be Ramsay Hunt syndrome
  • Both sides of the face affected
  • Gradually progressive weakness, recurrent episodes, or other neurologic symptoms
  • No improvement after about 3 weeks
Most people improve substantially within weeks to months, and many recover fully within 6 months. The NHS Bell's palsy guidance recommends prompt assessment and emphasizes steroid treatment and eye care.

cause for bells palsy

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"Bell Palsy" AND etiology

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Bell's palsy causes herpes simplex virus NHS

Bell's palsy is sudden weakness of one side of the face caused by inflammation and swelling of the facial nerve (cranial nerve VII).
The exact cause is not proven in every case, but the leading explanation is reactivation of dormant herpes simplex virus type 1 (HSV-1) in or near the facial nerve. The nerve then swells in the narrow bony facial canal, impairing its function. It is not usually the result of a new contagious infection.
Factors associated with a higher likelihood include:
  • Recent viral-type illness
  • Diabetes
  • Pregnancy, particularly late pregnancy or soon after delivery
  • High blood pressure
  • Possibly immune stress or reduced immunity
Important: Bell's palsy is a diagnosis of exclusion. Facial weakness can instead be due to stroke, shingles affecting the facial nerve (Ramsay Hunt syndrome, often with ear pain/blisters), Lyme disease, ear infection, tumor, or other neurologic illness. Progressive weakness, recurrent episodes, bilateral facial weakness, limb weakness, speech problems, or a severe headache need urgent medical assessment.
Cummings Otolaryngology Head and Neck Surgery identifies HSV reactivation as the principal etiology, while recognizing that Bell's palsy is diagnosed only after other causes are excluded.
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