Bell's Palsy

Bell’s Palsy
Usually a reactivation of HSV-1 or VZV. May also be caused by acute HIV, Lyme, Sarcoidosis. About 85% resolve with no sequelae. Prognosis is worse for severe initial presentations, and for those over age 50.1

H & P

[ ] Forehead involved? (Forehead-sparing would be central droop).
[ ] Hearing changes? (Stapedius may be paralyzed)
[ ] Vesicles in ears (i.e., Zoster) or signs of otitis media
[ ] tick exposures or rashes?
[ ] HIV risk factors, including IVDU or high-risk sexual practices
[ ] H/o sarcoid?

Management

[ ] Protect corneas with ATs QH during day, greasy lacralube at night. May need to tape eye shut at night.
[ ] Prednisone 60 mg QD x 6 days, then 40, 30, 20, 10, off.
- If neurosarcoidosis, still give steroids, but might give IV higher doses x days
[ ] Acyclovir 500 mg 5X daily for 10 days, or Valcyclovir 1 gm TID for 5 days
[ ] +/- HIV, Lyme serologies, Ca++
[ ] +/- Doxycycline 100 mg PO BID 10 days

[1] Peitersen E. The spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol 2002;(Suppl 549):4–30.

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