Bell’s Palsy

Publication Date: November 4, 2013
Last Updated: September 2, 2022


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
Clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis/paralysis in patients presenting with acute-onset unilateral facial paresis/paralysis. ( C , S )
Laboratory testing
Clinicians should NOT obtain routine laboratory testing in patients with new-onset Bell’s palsy. ( C , R )
Diagnostic imaging
Clinicians should NOT routinely perform diagnostic imaging for patients with new-onset Bell’s palsy. ( C , R )
Electrodiagnostic Testing
With incomplete paresis/paralysis
Clinicians should NOT perform electrodiagnostic testing in Bell’s palsy patients with incomplete facial paresis/paralysis. ( C , S )
With complete paresis/paralysis
Clinicians may offer electrodiagnostic testing to Bell’s palsy patients with complete facial paresis/paralysis. ( C , O )
Oral steroid use
Clinicians should prescribe oral steroids within 72 h of symptom onset for Bell’s palsy patients 16 y and older. ( A , S )
Antiviral Therapy
Clinicians should NOT prescribe oral antiviral therapy alone for patients with new-onset Bell’s palsy. ( A , S )
Clinicians may offer oral antiviral therapy in addition to oral steroids within 72 h of symptom onset for patients with Bell’s palsy. ( B , O )
Eye care
Clinicians should implement eye protection for Bell’s palsy patients with impaired eye closure. ( X , S )
Surgical decompression
No recommendation can be made regarding surgical decompression for Bell’s palsy patients. ( D , N)
No recommendation can be made regarding the effect of acupuncture in Bell’s palsy patients. ( B , N)
Physical therapy
No recommendation can be made regarding the effect of physical therapy in Bell’s palsy patients. ( C , N)
Patient Follow-up
Clinicians should reassess or refer to a facial nerve specialist those Bell’s palsy patients with (1) new or worsening neurologic findings at any point, (2) ocular symptoms developing at any point, or (3) incomplete facial recovery 3 mo after initial symptom onset. ( C , R )

Recommendation Grading




Bell’s Palsy

Authoring Organization

Publication Month/Year

November 4, 2013

Last Updated Month/Year

July 26, 2023

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Document Objectives

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

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Emergency care

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D020330 - Bell Palsy


Bell’s palsy, facial nerve disorder, idiopathic facial nerve paralysis

Source Citation

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