This guideline was based on the current body of evidence
regarding treatment of Bell's palsy. As determined by the
GDG's review of the literature, assessment of current clinical
practices, and determination of evidence gaps, research
needs were determined as follows:
- Consolidated Standards of Reporting Trials
(CONSORT) recommendations should be followed
in all RCTs, ensuring valid outcomes measures are
employed.139 The evaluation of patients prior to
treatment, during treatment, immediately following
treatment, and again months later, as well as collection
of quality-of-life data prior to and following
treatment, are all key components for a comprehensive
- The timing and outcomes for patients with and
without surgical facial nerve decompression need
to be compared. More specifically, the surgical
approach (ie, middle fossa), age (young vs old),
and time to improvement from onset of paresis/
paralysis to recovery (with levels of recovery) need
to be compared with traditional medical management
groups (ie, steroids and/or antivirals).
- Future clinical trials should compare eye care tactics
for patients with Bell's palsy to provide the basis
for stronger recommendations (eg, comparison of
the frequency of treatment or content of ointment).
- The benefits and risks of steroid use in children
with Bell's palsy need to be better elucidated.
- Further study is needed to more comprehensively
compare the concurrent use of combined steroids
and antiviral therapy on Bell's palsy outcomes.
Future trials may benefit from designs that allow
subgroup analysis to help identify which patients
are more likely to benefit from combination
- More rigorous randomized controlled trials are
needed to address the effectiveness of acupuncture.
- The efficacy of different physical therapy treatment
modalities on asymmetry, symmetry of voluntary
movement, and synkinesis in patients with Bell's
palsy needs to be elucidated.