# Bell's palsy (idiopathic facial paralysis) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: AAO-HNS Clinical Practice Guideline: Bell's Palsy 2013 - Verified date: 2026-08 ## Verified against - AAO-HNS Clinical Practice Guideline: Bell's Palsy 2013 - Bell's palsy (idiopathic facial paralysis) - disease-level clinical article (bell-palsy-clinical.txt) ## Treatment metadata - Prednisolone — 5 mg — oral.solid - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text BELL'S PALSY (IDIOPATHIC FACIAL PARALYSIS) Sources: AAO-HNS Clinical Practice Guideline: Bell's Palsy 2013 Review status: REVIEWED against AAO-HNS Clinical Practice Guideline: Bell's Palsy 2013, Bell's palsy (idiopathic facial paralysis) - disease-level clinical article (bell-palsy-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - Weakness on one side of the face develops and worsens to its worst point within 24 to 72 hours [facial weakness] - A dull ache in or behind the ear on the affected side often comes before the weakness starts [facial weakness] - Sounds can seem abnormally loud because of stapedius muscle weakness [muscle weakness] - A metallic taste or numb feeling on one side of the tongue can occur from chorda tympani involvement [taste disturbance] - The eye can feel paradoxically dry yet also tear, since both closure and the tear pump are affected - Nasal blockage on the weak side can result from nasalis muscle weakness [blocked nose · muscle weakness] - Slurred speech and trouble keeping food in the mouth can follow from orbicularis oris weakness [facial weakness · slurred speech] - A skin or mouth rash reported by the patient should raise suspicion for Ramsay Hunt syndrome or Lyme disease instead [rash] - Severe burning ear pain, rather than a dull ache, can point to zoster even before any rash appears [ear pain · rash] - Drooling noticed while brushing the teeth can be one of the first things the patient reports [drooling] - The lopsided face is often first noticed on waking, by the patient or by their partner - Loud noises can bring on pain in the ear on the weak side [ear pain] SIGNS - what you find (9) - Every branch of the facial nerve is weakened to about the same degree on the affected side - Forehead movement stays intact after a cortical stroke, unlike in Bell palsy [paralysis] - Weakness on both sides of the face, even if uneven, points away from Bell palsy toward Lyme disease or Guillain-Barre syndrome [facial weakness · paralysis] - A rash on the head or face together with facial weakness shifts the picture toward Ramsay Hunt syndrome [facial weakness · rash] - The reflex that rolls the eye up and out on attempted closure is present in most people, seen in 70% to 80% - The fold beside the nose and mouth may look flatter and more upright on the weak side - Smiling looks lopsided, with less mouth-corner pull, lip lift, and lip drop on the weak side - Severity is staged using the House-Brackmann grading system - Wetting of 10 mm or more on a Schirmer strip over 5 minutes is taken as normal tear production [urinary incontinence] TESTS (8) - Blood work and imaging are not needed for a typical, straightforward case - A neutrophil-to-lymphocyte ratio above 3.53 to 1 may hint at a worse recovery, though it is not routine - Electroneuronography and electromyography guide the decision on surgical nerve decompression - A 90% or greater drop in the muscle response on the weak side compared with the normal side counts as a positive ENoG - MRI can exclude a mass such as a meningioma or schwannoma pressing on the nerve - Contrast CT is useful for checking the geniculate ganglion and other otologic or extratemporal masses - Lyme titers are worth drawing if the patient has traveled to an area where the disease is common - Labs and imaging are reserved mainly for cases with a rash, other neurologic findings, a gradual start, or repeated episodes IF NOT THIS - what else fits (11) - Ramsay Hunt syndrome, including cases without a visible rash - Lyme disease, often marked by a target-shaped rash or history of a tick bite - Epstein-Barr virus, cytomegalovirus, or HIV infection are other viral causes to consider - Tuberculosis or COVID, usually with accompanying respiratory symptoms - A tumor such as facial nerve schwannoma or parotid mucoepidermoid carcinoma - Autoimmune disease such as Sjogren syndrome or Melkersson-Rosenthal syndrome - A stroke, cortical or brainstem, especially when other neurologic signs are present - Barotrauma from scuba diving or air travel - Brain metastasis or an effect of chemotherapy in a patient with a distant cancer - A complication of botulinum toxin injection that the patient may not volunteer - Ear disease such as acute otitis media or a chronic cholesteatoma Source StatPearls "Bell Palsy" - disease-level clinical article Status traced to the source above 1. PREDNISOLONE [1st line] Adult 60 mg daily for 5 days, then taper by 10 mg daily over 5 days x 10 days total Peds 1-2 mg/kg/day [child max 60 mg] (1-2 mg/kg once daily for 7 days (max 60 mg/day)) 3kg -> 3-6 mg/day 4kg -> 4-8 mg/day 5kg -> 5-10 mg/day 6kg -> 6-12 mg/day 7kg -> 7-14 mg/day 8kg -> 8-16 mg/day 9kg -> 9-18 mg/day 10kg -> 10-20 mg/day 11kg -> 11-22 mg/day 12kg -> 12-24 mg/day 13kg -> 13-26 mg/day 14kg -> 14-28 mg/day 15kg -> 15-30 mg/day 16kg -> 16-32 mg/day 17kg -> 17-34 mg/day 18kg -> 18-36 mg/day 19kg -> 19-38 mg/day 20kg -> 20-40 mg/day 21kg -> 21-42 mg/day 22kg -> 22-44 mg/day 23kg -> 23-46 mg/day 24kg -> 24-48 mg/day 25kg -> 25-50 mg/day 26kg -> 26-52 mg/day 27kg -> 27-54 mg/day 28kg -> 28-56 mg/day 29kg -> 29-58 mg/day 30kg -> 30-60 mg/day 31kg -> 31-60 mg/day (upper capped) 32kg -> 32-60 mg/day (upper capped) 33kg -> 33-60 mg/day (upper capped) 34kg -> 34-60 mg/day (upper capped) 35kg -> 35-60 mg/day (upper capped) 36kg -> 36-60 mg/day (upper capped) 37kg -> 37-60 mg/day (upper capped) 38kg -> 38-60 mg/day (upper capped) 39kg -> 39-60 mg/day (upper capped) 40kg -> 40-60 mg/day (upper capped) 41kg -> 41-60 mg/day (upper capped) 42kg -> 42-60 mg/day (upper capped) 43kg -> 43-60 mg/day (upper capped) 44kg -> 44-60 mg/day (upper capped) 45kg -> 45-60 mg/day (upper capped) 46kg -> 46-60 mg/day (upper capped) 47kg -> 47-60 mg/day (upper capped) 48kg -> 48-60 mg/day (upper capped) 49kg -> 49-60 mg/day (upper capped) 50kg -> 50-60 mg/day (upper capped) Source AAO-HNS Clinical Practice Guideline: Bell's Palsy 2013 Why Corticosteroid course that reduces inflammation and swelling around the facial nerve as it passes through its bony canal, improving the chance of full recovery; its benefit depends on starting within the window noted in the cautions. Caution INITIATE WITHIN 72 HOURS of symptom onset for maximum efficacy. EYE PROTECTION IS MANDATORY: lubricating drops by day, ointment and eye taping at night. Take steroid dose in morning with food to reduce insomnia. Egypt HOSTACORTIN H 5MG 30 TAB. SANOFI 12.00 EGP (0.40/unit) PREDNISOLONE 5 MG 20 TABS. ARAB DRUG COM... 24.00 EGP (1.20/unit) PREDILONE 5MG 10 TAB. (25 STRIPS PACK) KAHIRA 250.00 EGP (25.00/unit) EPICOPRED 5 MG 30 ORODISPERSIBLE TABS. EIPICO 69.00 EGP PREDNISOLONE-EVA 5 MG 30 ORODISPERSIBLE TABS. EVA PHARMA 79.50 EGP DISPRELONE-OD 5 MG 30 ORODISPERSABLE TABS. ANDALOUS PHARMA 84.00 EGP SOLUPRED ORO 5 MG 30 ORODISPERSIBLE TABS. SANOFI WINTHROP > SANOFI 84.00 EGP ACETASEE 1% EYE DROPS (SUSP.) 5 ML RAMEDA 7.50 EGP -> ? strength differs, ? different route - not oral solid PREDNIS 5MG/5ML SYRUP 100 ML PHAROPHARMA 9.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Bell's palsy (idiopathic facial paralysis) - disease-level clinical article (bell-palsy- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Evaluate for facial nerve decompression in severe grade VI paralysis without EMG motor units. RED FLAG - Imaging and laboratory workup are needed for atypical features, insidious onset, or recurrent paralysis. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)