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Last updated: 30 March, 2020 15:59pm

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Bell’s Palsy – Information for GPs

Exclude

  • Middle ear disease, Ramsay Hunt Syndrome, Parotid Neoplasm, CVA, Trauma
  • Children under 16 should always be referred via the on call ENT doctor
  • Patients who are pregnant or who have diabetes should also be referred in the same way

Management

If you are confident in excluding all of the above then current evidence suggests that early treatment with prednisolone 25mg bd for 10 days improves the chance of complete recovery to 83% at three months and 94.4% at nine months.  A change from previous treatment is that addition of acyclovir actually worsens outcomes so do not give it.

It would therefore be acceptable to start prednisolone and review the patient at one week (to ensure they are no worse) and then at six weeks (to ensure there is improvement).  If there is no improvement at six weeks the patient should be referred to ENT as above.

The patient should be warned that dryness of the eye caused by it not closing properly can be a serious complication if left untreated.

If there is incomplete eye closure the lid can be taped close with micropore at night and eye drops such as viscotears should be given four times daily with lacrilube eye ointment at night.

If there is concern about soreness of the eye or decrease in visual acuity the patient should be referred to ophthalmology.

Information to include in referral letter

  • If possible include a House Brackman score
  1. Normal symmetrical function in all areas
  2. Slight weakness noticeable only on close inspection. Complete eye closure with minimal effort.  Slight asymmetry of smile with maximum effort.  Synkinesis barely noticeable, contracture, or spasm absent
  3. Obvious weakness, but not disfiguring. May not be able to lift eyebrow.  Complete eye closure and strong but asymmetrical mouth movement with maximum effort.  Obvious, but not disfiguring synkinesis, mass movement or spasm
  4. Obvious disfiguring weakness. Inability to lift brow.  Incomplete eye closure and asymmetry of mouth with maximal effort.  Severe synkinesis, mass movement, spasm
  5. Motion barely perceptible. Incomplete eye closure, slight movement corner mouth.  Synkinesis, contracture, and spasm usually absent
  6. No movement, loss of tone, no synkinesis, contracture or spasm
  • Relevant past medical/surgical history
  • Current regular medication
  • Smoking status
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