Bell's palsy - Treatments

Steroid tablets plus antiviral tablets

Taking steroid tablets and antiviral tablets together may help you recover completely from Bell's palsy. They seem to work best if you take them within three days of your symptoms starting.[1] You'll probably need to take the tablets for a week.

The proper name for the type of steroids used is corticosteroids. A common type of corticosteroid that has been tested in people with Bell's palsy is prednisolone (brand name Deltacortil).

Antiviral tablets work on the virus that may be causing the problem. They will be either aciclovir (Zovirax) or valaciclovir (Valtrex).

We found one study of 119 people who either took prednisolone and aciclovir together, or just prednisolone on its own.[2] Taking both tablets in combination worked better than taking steroids only. After four months:

• Less than 1 in 10 people who took both medicines still had weak face muscles
• More than 2 in 10 people who only took prednisolone still had weak face muscles.

But almost 2 in 10 people dropped out of the study, so the results may not be very reliable.

Another small study showed that people treated with valaciclovir together with prednisolone recovered better than people who had no treatment.[3] But there were problems with the study, which means we can't rely on the results.

We don't know how well steroids or antiviral drugs work if you take them on their own. The studies show different things and there hasn't been enough good research.[2] [4] [5] [6]

Antiviral drugs have side effects but they're usually mild. For example, in one study 1 in 25 people felt sick and got diarrhoea after taking aciclovir.[4] You'll need to take aciclovir five times a day. You don't need to take valaciclovir as often.

Taking steroids for a long time and at a high dose can be harmful. The side effects include high blood pressure, diabetes, thinning of the bones and stomach ulcers.[7] You're unlikely to get these problems if you take steroids for only about a week. However, steroids can affect your mood after taking them for a short time. This can be serious. For example, some people get depressed or anxious, and in rare cases think about suicide. If you get any worrying symptoms while you're taking steroids, see a doctor straight away.

If you are pregnant, you should talk to your doctor or obstetrician before taking these drugs.

Surgery on the nerve in your face

We don't know whether surgery on the nerve in your face can be helpful for people with Bell's palsy. There haven't been any good studies. There are also serious risks with this operation.

This operation is called facial nerve decompression surgery. It isn't usually done for Bell's palsy in the UK.[8]

This is a serious operation. It's done while you are asleep under general anaesthetic. The aim of surgery is to release pressure on the nerve. The surgeon cuts through the skull and takes away the bone around the nerve.

Operating on the facial nerve is risky. It could make you permanently deaf in one ear. In one study, this happened to between 1 in 5 and 1 in 10 people who had the operation.[9]

Intensive physiotherapy

This is a form of physical therapy where you work with a specially trained therapist to strengthen the muscles of your face. It may make it easier for you to use your face muscles normally.

Surgery to help your eyes close

If Bell's palsy leaves you with one eye that does not close properly, you might consider an operation to help. A surgeon can put a weight into your eyelid to help it close more easily.[8]