Bell's palsy is treated with prednisolone. The addition of antiviral therapy (acyclovir/valacyclovir) to steroids is supported by evidence because:
- A HSV-1 reactivation in the geniculate ganglion is the proven etiology of Bell's palsy
- B Combination therapy significantly improves complete recovery compared to steroids alone in all patients
- C Current evidence shows modest additive benefit in severe cases; steroids remain the cornerstone ✓
- D Antivirals prevent post-herpetic neuralgia which commonly complicates Bell's palsy
Correct answer: C. Current evidence shows modest additive benefit in severe cases; steroids remain the cornerstone
Explanation
While HSV-1 reactivation is the widely accepted etiology of Bell's palsy, the evidence for combining antivirals with steroids is not unequivocal for all patients. The major randomized trials (Sullivan, Engstrom) showed that steroids alone significantly improve outcomes, while antiviral addition provides modest additive benefit at best, mainly in patients with complete/severe palsy. Current guidelines (AAOHNS) recommend steroids as the primary treatment and suggest adding antivirals for severe cases. Antivirals alone are inferior to steroids.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.