Bell’s Palsy
Diagnosis
When evaluating a patient with facial paresis/paralysis for Bell’s palsy, the following should be considered:
- Bell’s palsy is rapid in onset (<72 hours).
- Bell’s palsy is diagnosed when no other medical etiology is identified as a cause of the facial paresis/paralysis.
- Bilateral Bell’s palsy is rare.
- Currently, no cause for Bell’s palsy has been identified.
- Other conditions may cause facial paresis/paralysis, including stroke, brain tumors, tumors of the parotid gland or infratemporal fossa, cancer involving the facial nerve, and systemic and infectious diseases, including varicella zoster, sarcoidosis, and Lyme disease.
- Bell’s palsy is typically self-limited. Most patients with Bell’s palsy show some recovery without intervention within 2-3 weeks after onset of symptoms and completely recover within 3-4 months.
- Bell’s palsy may occur in men, women, and children but is more common in persons 15-45 years old; individuals with diabetes, upper respiratory ailments, or compromised immune systems; and during pregnancy.
Treatment
Table 4. Summary of Guideline Action Statements
Diagnostics
Patient history and physical examination
Laboratory testing
Diagnostic imaging
Electrodiagnostic Testing
With incomplete paresis/paralysis
With complete paresis/paralysis
Treatment
Steroids
Oral steroid use
Antiviral Therapy
Monotherapy
Combination
Other
Eye care
Surgical decompression
Acupuncture
Physical therapy
Patient Follow-up
Recommendation Grading
Overview
Title
Bell’s Palsy
Authoring Organization
American Academy of Otolaryngology - Head and Neck Surgery Foundation
Publication Month/Year
November 3, 2013
Last Updated Month/Year
December 19, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell's palsy, to improve the quality of care and outcomes for patients with Bell's palsy, and to decrease harmful variations in the evaluation and management of Bell's palsy. This guideline addresses these needs by encouraging accurate and efficient diagnosis and treatment and, when applicable, facilitating patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy.
Target Patient Population
Adults and children presenting with Bell’s palsy
Target Provider Population
All clinicians in any setting who are likely to diagnose and manage patients with Bell’s palsy
Inclusion Criteria
Male, Female, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Emergency care
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Treatment, Management
Diseases/Conditions (MeSH)
D020330 - Bell Palsy
Keywords
Bell’s palsy, facial nerve disorder, idiopathic facial nerve paralysis
Source Citation
Baugh RF, Basura GJ, Ishii LE, et al. Clinical Practice Guideline: Bell’s Palsy. Otolaryngology–Head and Neck Surgery. 2013;149(3_suppl):S1-S27. doi:10.1177/0194599813505967