Review: Steroid therapy improves facial recovery in patients with Bell's palsy

Objective To review disease characteristics and to determine the effectiveness of steroid therapy for facial recovery in padents with Bell's palsy. Data sources Studies were identified by hand searching the literature on facial paralysis using the Index Medims (1970 to 1995) and by searching MEDLINE and BIDS (1985 to 1995) using the keywords facial paralysis, Bell's palsy, steroids, drug therapy, prednisolone, adrenocorticotrophic hormone, cortisone, and steroid treatment. Additional studies were identified by scanning the bibliography of a relevant review; searching the Science Citation Index; contacting 6 steroid manufacturers; and contacting 5 ear, nose, and throat specialists. Study selection Studies were selected if they were randomised controlled trials (RCTs) that compared steroid therapy with either a placebo or an untreated control arm. Studies were excluded if the outcomes were difficult to categorize or if serious flaws in methods existed. Data extraction Data were extracted on recovery rates, study design, drug regimen, patient numbers and characteristics, and severity of palsy. Main results 4 studies were included in the analysis (392 patients, age range 5 to 70 y). All trials included complete and incomplete palsy. Recovery rates for nontreated Bell's palsy ranged from 57% to 85% for hospitalized patients. Full recovery was likely for patients with partial paralysis. 1 trial compared cortisone with placebo, 2 trials compared prednisolone with placebo, and 1 trial compared prednisolone with an untreated control arm. Follow-up was from 5 months to 1 year. Pooled data showed an improvement in the complete facial recovery rate in patients who received steroid treatment compared with those who received control treatment (77% vs 68%, {P = 0.03}*). {The weighted absolute ben-efit increase of 9% means that 11 patients would need to be treated with steroid therapy for 1 additional patient to completely recover, 95% CI 6 to 117; the relative benefit increase was 13%, CI 1% to 27%.}* None of the trials alone showed a difference in complete facial recovery rates between patients who received steroid therapy and patients in the control groups. 1 trial showed that autonomie synkinesis was reduced in patients who received steroid therapy compared with those who were left untreated. Conclusion Compared with placebo or no intervention, steroid therapy improves the complete facial recovery rate in patients with Bell's palsy.