Bell's palsy: Difference between revisions
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==Treatment== | ==Treatment== | ||
#Cornea | #Cornea eye protection (Level X)<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref> | ||
##Artificial tears qhr while pt is awake AND | ##Artificial tears qhr while pt is awake AND | ||
##Ophthalmic ointment at night | ##Ophthalmic ointment at night | ||
##Protective glasses or goggles | ##Protective glasses or goggles | ||
# | #Steroids + antiviral therapy for patients <72 hours of symptom onset (Level B)<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref> | ||
## | ##Corticosteroids | ||
##Prednisone 60-80mg qday x1wk<ref>UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref> | ###Prednisone 60-80mg qday x1wk<ref>UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref> | ||
#Antivirals | ##Antivirals | ||
# | ###Valacyclovir 1000mg TID x1wk<ref>UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref> | ||
##Valacyclovir 1000mg TID x1wk<ref>UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014</ref> | ####Or, Acyclovir 400mg 5x per day x 1wk | ||
###Or, Acyclovir 400mg 5x per day x 1wk | |||
==Disposition== | ==Disposition== | ||
*Discharge with ophtho f/u for monitoring of the affected cornea | *Discharge with ophtho f/u for monitoring of the affected cornea | ||
*Refer to a facial nerve specialist for:<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref> | |||
**New or worsening neurologic findings at any point | |||
**Ocular symptoms developing at any point | |||
**Incomplete facial recovery 3 months after initial symptom onset. | |||
==See Also== | ==See Also== | ||
Revision as of 21:39, 8 April 2014
Background
- Dysfunction of peripheral CN VII of unknown cause
- Maximal clinical weakness around 3wks; at least partial recovery by 6 months
- Always test CN VI function (should be normal) to rule-out CVA
Differential Diagnosis
- Lyme Disease
- HIV
- Otitis Media
- Sarcoidosis (esp if b/l)
Work Up
- Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy (Level C)[1]
Clinical Features
- Acute onset (over hours) of unilateral facial paralysis
- No forehead sparing
- Mouth drawn to the non-affected side
- Incomplete closure of the eyelids on the affected side
- Can lead to corneal exposure keratitis
Treatment
- Cornea eye protection (Level X)[2]
- Artificial tears qhr while pt is awake AND
- Ophthalmic ointment at night
- Protective glasses or goggles
- Steroids + antiviral therapy for patients <72 hours of symptom onset (Level B)[3]
Disposition
- Discharge with ophtho f/u for monitoring of the affected cornea
- Refer to a facial nerve specialist for:[6]
- New or worsening neurologic findings at any point
- Ocular symptoms developing at any point
- Incomplete facial recovery 3 months after initial symptom onset.
See Also
Source
- Tintinalli
References
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.