When evaluating a patient with facial paresis/paralysis for Bell’s palsy, the following should be considered:
- Bell’s palsy is rapid in onset (<72 hours).
- Bell’s palsy is diagnosed when no other medical etiology is identified as a cause of the facial paresis/paralysis.
- Bilateral Bell’s palsy is rare.
- Currently, no cause for Bell’s palsy has been identified.
- Other conditions may cause facial paresis/paralysis, including stroke, brain tumors, tumors of the parotid gland or infratemporal fossa, cancer involving the facial nerve, and systemic and infectious diseases, including varicella zoster, sarcoidosis, and Lyme disease.
- Bell’s palsy is typically self-limited. Most patients with Bell’s palsy show some recovery without intervention within 2-3 weeks after onset of symptoms and completely recover within 3-4 months.
- Bell’s palsy may occur in men, women, and children but is more common in persons 15-45 years old; individuals with diabetes, upper respiratory ailments, or compromised immune systems; and during pregnancy.
Table 4. Summary of Guideline Action Statements
Patient history and physical examination
With incomplete paresis/paralysis
With complete paresis/paralysis
Oral steroid use
November 4, 2013
Last Updated Month/Year
July 26, 2023
External Publication Status
Country of Publication
The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell’s palsy, to improve the quality of care and outcomes for patients with Bell’s palsy, and to decrease harmful variations in the evaluation and management of Bell’s palsy.
Target Patient Population
Adults and children presenting with Bell’s palsy
Target Provider Population
All clinicians in any setting who are likely to diagnose and manage patients with Bell’s palsy
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Emergency care
Nurse, nurse practitioner, physician, physician assistant
Diagnosis, Management, Treatment
D020330 - Bell Palsy
Bell’s palsy, facial nerve disorder, idiopathic facial nerve paralysis
Baugh RF, Basura GJ, Ishii LE, et al. Clinical Practice Guideline: Bell’s Palsy. Otolaryngology–Head and Neck Surgery. 2013;149(3_suppl):S1-S27. doi:10.1177/0194599813505967