title: Are corticosteroid and antiviral treatments effective for bell palsy? A critically appraised topic.
abstract: BACKGROUND
  : Bell palsy is idiopathic peripheral facial weakness that typically resolves without severe clinical sequelae. Treatment with corticosteroids and antiviral drugs is often initiated to improve the likelihood of a favorable outcome.
  
  
  OBJECTIVE
  : Are corticosteroid and antiviral medications effective in the treatment of Bell palsy?
  
  
  METHODS
  : The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a structured question, search strategy, critical appraisal, results, evidence summary, commentary, pre- and postassessment, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and a clinical content expert in the field of Otolaryngology.
  
  
  RESULTS
  : The largest (18 trials involving 2786 patients) current systematic review and meta-analysis for pharmacologic treatment of Bell palsy was selected for appraisal. The meta-analysis demonstrated a clear benefit of oral corticosteroids, alone, in preventing unsatisfactory recovery of facial weakness (relative risk, 0.69 [95% confidence interval {CI}, 0.55-0.87], number needed to treat 11 [95% CI, 8-25]). Treatment with antiviral medication, alone, was not associated with a reduced risk of unsatisfactory recovery. When administered concurrently with corticosteroids, antiviral treatments displayed a trend toward reduced risk of unsatisfactory recovery, compared with corticosteroids alone (relative risk, 0.75 [95% CI, 0.56-1.00]).
  
  
  CONCLUSIONS
  : Corticosteroids effectively reduce the risk of an unfavorable outcome in Bell palsy. Antiviral agents, when administered concurrently with corticosteroids, may result in additional benefit.
authors.affiliation: Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
authors.forename: Greg M
authors.initials: GM
authors.lastname: Thaera
authors.forename: Kay E
authors.initials: KE
authors.lastname: Wellik
authors.forename: David M
authors.initials: DM
authors.lastname: Barrs
authors.forename: Erika D Driver
authors.initials: ED
authors.lastname: Dunckley
authors.forename: Dean M
authors.initials: DM
authors.lastname: Wingerchuk
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D015201:Meta-Analysis as Topic; D012196:Review Literature as Topic; D012306:Risk; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents