How effective are corticosteroids in the treatment of Bell's Palsy, and what is the optimal timing for their administration?

Corticosteroids are effective in the treatment of Bell's palsy, significantly improving recovery of facial motor function. A Cochrane systematic review showed that corticosteroid treatment reduced the risk of incomplete recovery of motor function from 28% in untreated patients to 17% in those treated with corticosteroids, with a risk ratio of 0.63 (95% CI 0.50 to 0.80) and a number needed to treat of 10 to prevent one case of incomplete recovery ¹.

The optimal timing for corticosteroid administration is within 72 hours of symptom onset. Treatment should be considered for people aged 16 years and older presenting within this timeframe ¹.

Recommended dosing regimens include either 50 mg prednisolone daily for 10 days or 60 mg daily for 5 days followed by a tapering dose reduction of 10 mg daily over the next 5 days, totaling 10 days of treatment. There is no consensus on the exact dosing regimen, but these are commonly used options ¹.

Antiviral treatments alone are not recommended, and combined corticosteroid and antiviral therapy is not routinely advised due to insufficient evidence of added benefit over corticosteroids alone. However, combined therapy may be considered in severe cases after specialist advice ¹.