Bell's Palsy

Exclude –

  • Stroke – relative sparing of forehead movement
  • Ramsay Hunt Syndrome – blisters on cochal bowl/ear canal/TM/palate
  • Cholesteatoma as rare cause

Try: Oral Prednisolone 40-60 mg daily for 1/5with PPI cover. 

Avoid antivirals unless Ramsay Hunt (evidence for poorer facial nerve recovery).

Eye Care Essential-Tape eye (NOT a patch) at night and lubrication to prevent corneal ulceration. Useful videolink for patients. 

Refer if:  Urgently if additional evidence of ear infection and hearing loss only

If not resolving in 6/52 refer as a routine referral to ENT.  

Parotid or Neck Mass refer as RED FLAG

Investigations required:  Otoscopy