Steroid-antiviral treatment improves the recovery rate in patients with severe Bell's palsy

Am J Med. 2013 Apr;126(4):336-41. doi: 10.1016/j.amjmed.2012.08.020. Epub 2013 Feb 6.


Background: The extent of facial nerve damage is expected to be more severe in higher grades of facial palsy, and the outcome after applying different treatment methods may reveal obvious differences between severe Bell's palsy and mild to moderate palsy. This study aimed to systematically evaluate the effects of different treatment methods and related prognostic factors in severe to complete Bell's palsy.

Methods: This randomized, prospective study was performed in patients with severe to complete Bell's palsy. Patients were assigned randomly to treatment with a steroid or a combination of a steroid and an antiviral agent. We collected data about recovery and other prognostic factors.

Results: The steroid treatment group (S group) comprised 107 patients, and the combination treatment group (S+A group) comprised 99 patients. There were no significant intergroup differences in age, sex, accompanying disease, period from onset to treatment, or results of an electrophysiology test (P >.05). There was a significant difference in complete recovery between the 2 groups. The recovery (grades I and II) of the S group was 66.4% and that of the S+A group was 82.8% (P=.010). The S+A group showed a 2.6-times higher possibility of complete recovery than the S group, and patients with favorable electromyography showed a 2.2-times higher possibility of complete recovery.

Conclusions: Combined treatment with a steroid and an antiviral agent is more effective in treating severe to complete Bell's palsy than steroid treatment alone.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acyclovir / analogs & derivatives
  • Acyclovir / therapeutic use*
  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents / therapeutic use*
  • Bell Palsy / drug therapy*
  • Drug Therapy, Combination
  • Electromyography / methods
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prednisone / therapeutic use*
  • Prognosis
  • Prospective Studies
  • Recovery of Function / drug effects
  • Severity of Illness Index


  • Antiviral Agents
  • Glucocorticoids
  • Prednisone
  • Acyclovir