Early use of steroids has been established as standard management in Bell’s palsy but simultaneous use of antiviral agents has variable acceptance. This review article analyses statistically based evidence to settle the issue. High quality evidence from a 2009 Cochrane review did not show significant benefit from antiviral treatment compared to placebo and antivirals were less effective compared to corticosteroids. However, this does not refer to combination therapy. A number of shortcomings have been cited in this review. A series of prospective trials comparing combination therapy with steroids only has in general, shown much better results with the former. The authors have illustrated that leaving out studies with most ‘positive’ results and most ‘negative’ results, combination therapy is distinctly better, and they state that the full dose of antivirals, also to cover herpes simplex, should be used with corticosteroids. The issue of decompression surgery is addressed favourably with emphasis towards early intervention in patients with complete paralysis and in those with electro-physiological confirmation of poor recovery prospects. The surgery should include decompression medial to the geniculate ganglion. However, to avoid collateral damage of surgery, the operation should be done by only those few who are adequately skilled.

Antiviral agents convey added benefit over steroids alone in Bell’s palsy; decompression should be considered in patients who are not recovering.
De Ru JA, Brennan PA, Martens E.
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Madhup K Chaurasia

United Lincolnshire Hospitals NHS Trust; University of Leicester, UK.

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