Canada now has its first-ever guideline on Bell’s Palsy, which was published in CMAJ in 2014. Like any national guideline, it’s helpful to be familiar with it before your exam.
Quiz yourself:
1. T/F: Choosing either corticosteroids or antiviral treatment are recommended for patients with moderate or severe Bell’s palsy only
2. T/F: The new guidelines recommend avoiding antivirals in patients with Bell’s palsy as evidence is limited.
Remember: as you'll learn in The Review Course, Management = More than Medication, so it’s useful to know some non-pharmacologic treatments in case you are asked to write or say these on an exam:
3. T/F: Electrostimulation is recommended for patients with Bell’s palsy.
4. T/F: Exercise physiotherapy is recommended for patients with Bell’s palsy.
5. T/F: Surgical decompression is not routinely recommended for patients with Bell’s palsy.
ANSWERS:
1. T/F: Corticosteroids are recommended for patients with moderate or severe Bell’s palsy only.
Correct answer: FALSE. The guideline recommends ALL patients with Bell’s palsy be started on steroids.
2. T/F: The new guidelines recommend avoiding antivirals in patients with Bell’s palsy as evidence is limited.
Correct answer: FALSE. There is weak evidence to suggest that antivirals are helpful, IF they are added to corticosteroids. The guidelines say do NOT prescribe antivirals alone.
3. T/F: Electrostimulation is recommended for patients with Bell’s palsy.
Correct answer: FALSE.
4. T/F: Exercise physiotherapy is recommended for patients with acute Bell’s palsy.
Correct answer: FALSE. No recomendation is made for the acute phase, but if the deficit persists, there is a weak recommendation to use exercise physiotherapy for chronic Bell's palsy.
5. T/F: Surgical decompression is not routinely recommended for patients with Bell’s palsy.
Correct answer: TRUE.
BONUS TIP:
Don’t forget to include eye-protective measures for your patients with Bell’s palsy if their eye lid function is affected.
If the Bell's palsy becomes prolonged, think, "What else could it be?" Consider referral at that time, and in this scenario, imaging is recommended by the guidelines.
Source
CMAJ. 2014 Sep 2; 186(12): 917–922.