Corticosteroids, Antivirals, Both, or Neither for Bell Palsy?

Bell palsy usually resolves completely without treatment, but roughly 30% of patients have residual neurological deficits, half of which are substantial. To prevent these sequelae, Bell palsy patients often receive corticosteroids, antiviral agents, or both, but clinical trials and reviews have shown mixed results for these treatment strategies. In this new meta-analysis, researchers evaluated 18 randomized controlled studies (8 of corticosteroids alone, 7 of antiviral agents alone, and 3 of both together) that involved 2786 patients. Not all studies were blinded. Median follow-up was 6 months.

Risk for unfavorable outcome was lowered from about 29% to 20% when corticosteroids were used alone (11 patients needed to be treated to prevent 1 un…