Clinical, laboratory, and electrophysiological prognostic factors of Bell’s palsy outcome

Background Bell’s palsy is an idiopathic, acute peripheral facial nerve palsy causing unilateral facial weakness, with an estimated lifetime risk of one in 60. Although most patients recover fully, up to 30% experience long-term sequelae, including permanent weakness or synkinesis. Factors influencing prognosis include clinical presentation, electrophysiological findings, and inflammatory markers, but their combined predictive value remains underexplored. Aim This study aimed to correlate clinical, electrophysiological, and laboratory findings in Bell’s palsy patients to identify prognostic predictors. Patient and methods A cross-sectional observational study was conducted on 30 patients with acute unilateral Bell’s palsy (onset within 7 days) at Tanta University’s Neuropsychiatric Department from March to May 2025. Patients aged 18–55 years were assessed using the House-Brackmann (HBS), electroneurography, and electromyography on days 7 and 21. Inflammatory markers [neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and albumin] were measured. Statistical analyses included Pearson’s correlation, multivariate linear regression, and receiver operating characteristic curve analysis. Results Older age, higher initial HBS, greater amplitude degeneration on electroneurography, and reduced volitional activity on electromyography were associated with poorer outcomes. Elevated NLR and CRP, and lower albumin levels, correlated with worse prognosis. Multivariate regression identified initial HBS, volitional activity, denervation potentials, NLR, CRP, and albumin as independent predictors. Receiver operating characteristic analysis revealed albumin (≤3.8 g/dl) as the strongest predictor (92.3% sensitivity, 94.1% specificity). Conclusion Clinical, electrophysiological, and laboratory markers, particularly albumin, NLR, and CRP, are robust predictors of Bell’s palsy prognosis, enabling enhanced risk stratification.