The effect of prednisolone and/or acyclovir in relation to severity of Bell’s palsy at presentation

ObjectivesTo evaluate the efficacy of prednisolone and/or acyclovir in the treatment of Bell’s palsy in relation to severity at the first visit.DesignA prospective, randomised, placebo-controlled study.SettingFour public outpatient ENT clinics.Patients603 patients aged 18–70 years were treated within 72 h of palsy onset. Patients were assigned to three groups; group 1 treated with prednisolone plus placebo (n = 198), group 2 treated with acyclovir plus placebo (n = 203), and group 3 treated with prednisolone plus acyclovir (n = 202). Each group was divided into three subgroups according to severity of palsy at presentation using the Sunnybrook score; severe; moderate and mild. Point of assessment was at the end of the 12th month.Main outcome measuresFacial function and synkinesis were evaluated for correlation to severity of palsy at baseline.ResultsIn patients with severe palsy, complete recovery at 12 months was 56% with prednisolone, 41.6% with acyclovir and 55.5% in prednisolone plus acyclovir group. In patients with moderate palsy, recovery was 64.5%, 56.6% and 70.2% in groups 1, 2 and 3 respectively. In patients with mild palsy, recovery was 92%, 62.6% and 91.5% in groups 1, 2 and 3, respectively. Complete recovery and absence of slinkiness results were correlated to the baseline severity. Group 3 had significant higher results in moderate palsy cases.ConclusionPrednisolone treatment resulted in higher complete recovery rates, regardless of severity at presentation. Prednisolone treatment should be considered in all patients irrespective of degree of palsy.