A 35-year-old woman presents with a sudden complete left Bell's palsy of 12 hours duration. She has no contraindication to steroids. Which management offers the best chance of complete recovery?
- A Facial nerve decompression surgery within 48 hours
- B Oral acyclovir monotherapy for 7 days
- C Oral prednisolone 1 mg/kg/day started now, with taper over 10 days ✓
- D Observation with physiotherapy, since most patients recover fully regardless of treatment
Correct answer: C. Oral prednisolone 1 mg/kg/day started now, with taper over 10 days
Explanation
High dose oral corticosteroids, typically prednisolone 1 mg/kg/day (often up to 60 mg) begun within 72 hours of onset and continued for 5 to 10 days, significantly increase the rate of complete recovery in Bell palsy and are standard first line therapy. Antivirals alone are inferior, though they are commonly added to steroids in severe or complete palsies on the assumption of herpes simplex reactivation. Surgical decompression is reserved for selected refractory cases with >90% degeneration on serial ENoG, and observation forfeits the proven benefit of early steroids.
Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.