Background: Bell’s palsy is an idiopathic condition, caused by inflammatory injury to the facial nerve, resulting in a unilateral facial paralysis. This disfiguring disorder affects about 40 000 people in the U.S. each year and although many recover without treatment, there are serious physical and psychological complications for those that fail to recover completely. Due to its unknown etiology, the preferred treatment of Bell’s palsy has been the subject of controversy for sometime. Current practice has demonstrated the use of steroids to counteract the inflammatory process and/or antivirals because of a hypothesized viral etiology. Does the use of antivirals alone or in conjunction with steroids substantially increase the overall recovery in patients with Bell’s palsy?
Methods: An exhaustive search was conducted using Medline-OVID, CINAHL-EBSCOhost, EBMR Multifile, and Web of Science using the keywords: Bell’s palsy, antiviral agents and prednisone or prednisolone. The NIH clinical trials site revealed no on-going or registered trials comparing the treatment of steroids and antivirals in patients with Bell’s palsy. Relevant articles were assessed for quality using GRADE.
Results: Two randomized, double blind, placebo-controlled trials were included in this systematic review. One trial, with 829 participants, demonstrated a statistically significant increase in the recovery of patients treated with prednisolone as compared to valaciclovir. A second trial, with 496 participants, demonstrated a statistically significant increase in the recovery of patients treated with prednisolone as compared to aciclovir.
Conclusion: When initiated within 72 hours of symptom onset, prednisone has been shown to increase the overall number and rate of recoveries in patients being treated for Bell’s palsy. The use of antivirals alone, as compared to placebo, did not increase the number of recoveries and in some cases slowed the rate at which patients recovered. Furthermore, when compared to prednisone alone, these two trials failed to produce results of statistically significant improvement in recovery when administering combination therapy of prednisone plus antivirals. This raises question as to whether combination therapy should be considered at all until further research proves a statistically significant improvement or a true etiology for Bell’s palsy is identified.
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