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Clinical Challenges in Otolaryngology
July 1998

Combination Treatment With Acyclovir and Prednisone for Bell Palsy

Author Affiliations

Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

Arch Otolaryngol Head Neck Surg. 1998;124(7):824. doi:10.1001/archotol.124.7.824

Bell palsy is progressive for 7 to 10 days and we are unable to predict which patients will develop the more severe form. Therefore, in selecting patients for treatment, it is inappropriate to rely on deterioration from incomplete to complete paralysis or on results of electrical tests. Nerve conduction does not become abnormal until 3 days after degeneration has occurred. Because treatment is designed to prevent nerve degeneration and, later, faulty regeneration that leads to midfacial contracture with synkinesis, treatment should begin before electrical tests results show abnormalities. Furthermore, it has been shown by diligent electromyographic sampling of the facial muscles of patients with Bell palsy that all have some muscle denervation (as recorded by fibrillation potentials). We advise that all patients start treatment immediately following the onset of palsy, and that treatment be modified 1 week later, depending on whether paralysis has progressed.