Corticosteroids vs. Combined Corticosteroid/Antiviral Therapy in Bell's Palsy Treatment: A Randomized Controlled Trial

Ranj  Salaei; Shehab  Hamad; Ahmed  Alraad; Osamah  Ahmed; Mustafa  Ahmed

doi:10.56056/amj.2025.388

Authors

Ranj Salaei Lecturer, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tishk International University, Erbil, Iraq
Shehab Hamad Professor, Faculty of Dental Specialties, Kurdistan Higher Council of Medical Specialties, Erbil, Iraq
Ahmed Alraad Trainee Doctor, St. Rocco’s Hospice (NHS) –Palliative Care, Warrington, UK
Osamah Ahmed Junior Doctor, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Mustafa Ahmed Student, College of Medicine, University of Mosul, Mosul, Iraq

DOI:

https://doi.org/10.56056/amj.2025.388

Keywords:

Antiviral therapy, Bell's palsy, Corticosteroids, Facial nerve paralysis

Abstract

Background and Aim: Bell's palsy is the most common cause of acute unilateral facial nerve paralysis. While corticosteroids are established as first-line treatment, the additional benefit of antiviral therapy remains controversial. The aim of the study is comparing the efficacy of corticosteroids alone versus combination therapy (corticosteroids plus antiviral agents) in the treatment of Bell's palsy.

Methods: This randomized, double-blind, placebo-controlled trial enrolled 36 patients with acute Bell's palsy presenting within 72 hours of symptom onset. Patients were randomized to receive either prednisolone monotherapy (n=18) or combination therapy with prednisolone plus acyclovir (n=18). Primary outcome was complete facial nerve recovery at 12 weeks using the House-Brackmann Facial Nerve Grading System.

Results: The combination therapy group demonstrated superior outcomes with 89% recovery rate compared to 78% in the corticosteroids-only group (p < 0.048). Complete recovery was achieved in 72% of combination therapy patients versus 61% in the monotherapy group. Mean recovery time was 5.6 weeks for combination therapy compared to 6.4 weeks for corticosteroids alone.

Conclusion: Combination therapy with corticosteroids and antiviral agents shows promising benefits over corticosteroids alone in Bell's palsy treatment, with higher recovery rates and faster recovery times.

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