title: Management of Bell's palsy in children: an audit of current practice, review of the literature and a proposed management algorithm.
abstract: OBJECTIVE
  We carried out a complete audit cycle, reviewing our management of paediatric patients with Bell's palsy within 72 h of symptom onset. Our protocol was published after the initial audit in 2009, and a re-audit was carried out in 2011. We aimed to improve our current practice in accordance with up-to-date evidence-based research on the use of steroids and antivirals.
  
  
  METHODS
  A total of 17 patients were included in the first cycle, but only eight patients met our inclusion and exclusion criteria for the re-audit. We assessed documentation of House-Brackmann (HB) grade on presentation, initial treatment, follow-up and recovery.
  
  
  RESULTS
  The first cycle revealed inconsistent management with steroids (41%), antivirals (6%), steroids and antivirals (6%) or nothing at all (47%). In addition, only 65% of patients were followed-up in the ear, nose and throat (ENT) clinic. Our management protocol was published in 2010, and a re-audit was completed. Our results showed 100% compliance with steroid treatment and 100% follow-up with the ENT team. A thorough literature review revealed some additional benefit from the use of antivirals.
  
  
  CONCLUSIONS
  At present there is insufficient evidence to discount the use of steroids and antivirals. Therefore, with our new management protocol, we recommend the use of steroids in patients presenting within 72 h of symptom onset, and antivirals for patients with a HB grade of IV or higher.
authors: Department of Otolaryngology, Salford Royal NHS Foundation Trust, Salford, UK.
authors: Amir Saam
authors: AS
authors: Youshani
authors: Department of Accident & Emergency, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
authors: Bimal
authors: B
authors: Mehta
authors: Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
authors: Katharine
authors: K
authors: Davies
authors: Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
authors: Helen
authors: H
authors: Beer
authors: Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
authors: Sujata
authors: S
authors: De
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000998:Antiviral Agents / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D006801:Humans; D007223:Infant; D008485:Medical Audit; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D013256:Steroids
keywords: Audit; Clincial Management; ENT; Paediatric Emergency Med; Teaching