Management, Referral Patterns, and Outcomes in Bell's Palsy: A Single‐Institution 903 Patient Series

• Published in: Otolaryngology-head and neck surgery 2023-10, Vol.169 (4), p.858-864
• Main Authors: Liu, Sara W., Wright, Darrell T., Abramczyk, Emily, Hadford, Stephen P., Genther, Dane J., Byrne, Patrick J., Fritz, Michael A., Ciolek, Peter J.
• Format: Article
• Language: English
• Subjects: Bell's palsy; facial paralysis; facial reanimation
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1002/ohn.313

Objective In 2013, the American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS) published guidelines for Bell's palsy (BP), including recommendations for workup, management, and specialist referral. Patients with BP often present to primary care; however, adherence to guidelines may vary by setting. This study sought to evaluate the management of patients with BP presenting to primary care, emergency department (ED), and urgent care settings. Study Design Retrospective cohort study. Setting Tertiary care center. Methods Retrospective chart review of patients identified by diagnosis code for BP. Results A total of 903 patients were included; 687 (76.1%) presented to ED, 87 (9.6%) to internal medicine, 77 (8.5%) to family medicine, and 52 (5.8%) to urgent care. On presentation, 804 (89.0%) patients were prescribed corticosteroids and 592 (65.6%) antiviral therapy. Steroid therapy ranged from 1 dose to greater than a 14‐day course, with 177 (19.6%) receiving an adequate duration of 10 days or greater. Referrals were provided to facial plastics and/or otolaryngology for 51 patients (5.6%). For all comers, 283 (31.3%) had complete resolution, 197 (21.8%) had an incomplete resolution, 62 (6.9%) had persistent palsy, and 361 (40.0%) lost to follow‐up. In assessing the association between clinic setting and management, appropriate corticosteroid therapy (p