Treatment
Table 4. Summary of Guideline Action Statements
Diagnostics
Action Recommendation Strength
Patient history
and physical
examination
Clinicians should assess the patient using history and
physical examination to exclude identifiable causes of facial
paresis/paralysis in patients presenting with acute-onset
unilateral facial paresis/paralysis
C-S
Laboratory
testing
Clinicians should NOT obtain routine laboratory testing in
patients with new-onset Bell's palsy
C-R
Diagnostic
imaging
Clinicians should NOT routinely perform diagnostic
imaging for patients with new-onset Bell's palsy
C-R
Electrodiagnostic Testing
With incomplete
paresis/paralysis
Clinicians should NOT perform electrodiagnostic testing in
Bell's palsy patients with incomplete facial paresis/paralysis
C-S
With complete
paresis/paralysis
Clinicians may offer electrodiagnostic testing to Bell's palsy
patients with complete facial paresis/paralysis
C-O
Treatment
Action Recommendation Strength
Steroids
Oral
steroid use
Clinicians should prescribe oral steroids within 72 h of
symptom onset for Bell's palsy patients 16 y and older
A-S
Antiviral Therapy
Monotherapy Clinicians should NOT prescribe oral antiviral therapy alone
for patients with new-onset Bell's palsy
A-S
Combination Clinicians may offer oral antiviral therapy in addition to
oral steroids within 72 h of symptom onset for patients with
Bell's palsy
B-O
Other
Eye care Clinicians should implement eye protection for Bell's palsy
patients with impaired eye closure
X-S
Surgical
decompression
No recommendation can be made regarding surgical
decompression for Bell's palsy patients
D-N
Acupuncture No recommendation can be made regarding the effect of
acupuncture in Bell's palsy patients
B-N
Physical
therapy
No recommendation can be made regarding the effect of
physical therapy in Bell's palsy patients
D-N
Patient Follow-up
Clinicians should reassess or refer to a facial nerve specialist those Bell's palsy
patients with (1) new or worsening neurologic findings at any point, (2) ocular
symptoms developing at any point, or (3) incomplete facial recovery 3 mo aer
initial symptom onset
C-R
