Bell’s Palsy Management: A Controversial Treatment Issue

Background: Bell’s palsy (BP) is an acute, idiopathic, unilateral facial nerve paralysis with spontaneous recovery in some cases, yet its optimal management remains debated. Corticosteroids and antivirals are mainstays of pharmacologic therapy, though their relative efficacy still poses much controversy. Objective: To compare clinical outcomes in BP cases treated with corticosteroids alone, corticosteroids plus antivirals, or supportive treatment only. Patients and Methods: This prospective randomized clinical trial enrolled 144 cases diagnosed with acute unilateral BP at Menoufia University Hospital between March 2023 and August 2024. Eligible cases were adults (≥18 years) with symptom onset ≤7 days. Cases were stratified into three groups (n=48 each): Group A received oral prednisolone; Group B received prednisolone plus acyclovir; and Group C received supportive treatment only. All cases underwent standard clinical assessment and were followed for up to 6 months. Facial nerve function was evaluated using HBS. Results: The mean age was 31.04 ± 9.64 years; 61.8% were males. At final follow-up, complete recovery (HBS Grade I) occurred in 70.9% of Group A, 66.7% of Group B, and 45.8% of Group C (p=0.023). Recovery within 2 months was achieved in 81.2% of Group A, 72.9% of Group B, and 52.1% of Group C (p=0.001). There was no significant additional benefit from combining acyclovir with corticosteroids. Severity at presentation significantly impacted prognosis (p < 0.001). Conclusions: Steroid therapy significantly improves recovery rates and accelerates facial nerve function restoration in BP. Adding antivirals provides no additional benefit and may be reserved for severe cases or suspected viral reactivation.