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Lyme titers or monospot if high suspicion for viral etiology) Consider blood glucose in Bell’s Palsy patients with other diabetic risk factors as 10% of Bell’s Palsy patients have diabetes ED Management: Glucocorticoids may hasten recovery if started within 72 hours of symptom onset: 1mg/kg prednisone (or 60 to 80 mg) PO daily for 7 days (pediatric dose: 2mg/ kg/ day PO [max 60mg]) NNT to prevent one incomplete recovery = 10 No clear regimen, most studies use 7-10 days of PO prednisone Anti-viral therapy with steroids may improve functional nerve recovery if started within 72 hours of symptom onset: valacyclovir 1000 mg PO daily for 7 days (pediatric dose: 20mg/ kg TID PO) Low quality evidence that antivirals with glucocorticoids is superior to glucocorticoids alone American Academy of Neurology recommends offering antivirals while explaining limited evidence but also limited harm Corneal damage may occur due to incomplete eye closure prescribe lubricating and hydrating ophthalmic ointment and/ or drops (artificial tears qhs and prn dryness/ irritation in affected eye) instruct patient on wearing eye patch at night on affected eye Prognosis: In the Copenhagen Facial Nerve Study (2002), 2,570 cases of untreated peripheral facial nerve palsy were studied during a period of 25 years (1,701 cases of Bell’s palsy) 71% of Bell’s palsy patients returned to baseline function in three weeks without treatment Almost all patients noticed some improvement in three to four months Prognosis is related to initial severity: with incomplete lesions, 94% returned to baseline whereas of those with complete lesions, 60% returned to baseline Patient Education and Discharge Instructions: While not life threatening, Bell’s palsy can cause significant distress Symptoms peak within three to seven days, and almost always improve somewhat by 3 months With incomplete lesions, ~95% return to baseline