Efficacy of early treatment of Bell's palsy with oral acyclovir and prednisolone

Otol Neurotol. 2003 Nov;24(6):948-51. doi: 10.1097/00129492-200311000-00022.


Objective: To investigate the therapeutic effects of acyclovir and prednisolone in relation to the timing of treatment in Bell's palsy.

Study design: This was a retrospective study of 480 Bell's palsy patients who were treated with oral acyclovir and prednisolone (94 cases) or prednisolone alone (386 cases).

Patients: Patients met the after criteria: (1) severe or complete Bell's palsy with a score lower than 20 on the 40-point Yanagihara facial score and (2) treatment started within 7 days after onset. The patients were treated with oral prednisolone (60-40 mg/day) with or without oral acyclovir (2,000 mg/day).

Main outcome measure: Rate of recovery, which was defined as a facial score of 36 or more, and the absence of contracture with synkinesis.

Results: The overall recovery rate of patients treated with acyclovir and prednisolone was 95.7 percent, which was better than that of patients treated with prednisolone alone (88.6%). The recovery rate in patients who began the combined therapy within 3 days of the onset of palsy was 100 percent and early treatment resulted in early remission. In contrast, the recovery rate in patients who started the combined therapy more than 4 days after onset was 86.2 percent.

Conclusion: These results suggest that early diagnosis and treatment within 3 days of the onset of paralysis are necessary for maximal efficacy of combined acyclovir and prednisolone therapy for Bell's palsy.

MeSH terms

  • Acyclovir / therapeutic use*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents / therapeutic use*
  • Antiviral Agents / therapeutic use*
  • Bell Palsy / drug therapy*
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Early Diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prednisolone / therapeutic use*
  • Retrospective Studies
  • Time Factors
  • Treatment Outcome


  • Anti-Inflammatory Agents
  • Antiviral Agents
  • Prednisolone
  • Acyclovir