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Guidelines

Management of Bell palsy: clinical practice guideline

John R. de Almeida, Gordon H. Guyatt, Sachin Sud, Joanne Dorion, Michael D. Hill, Michael R. Kolber, Jane Lea, Sylvia Loong Reg, Balvinder K. Somogyi, Brian D. Westerberg, Chris White, Joseph M. Chen and Bell Palsy Working Group, Canadian Society of Otolaryngology – Head and Neck Surgery and Canadian Neurological Sciences Federation
CMAJ September 02, 2014 186 (12) 917-922; DOI: https://doi.org/10.1503/cmaj.131801
John R. de Almeida
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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  • For correspondence: john.dealmeida@utoronto.ca
Gordon H. Guyatt
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Sachin Sud
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Joanne Dorion
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Michael D. Hill
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Michael R. Kolber
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Jane Lea
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Sylvia Loong Reg
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Balvinder K. Somogyi
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Brian D. Westerberg
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Chris White
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Joseph M. Chen
Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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Department of Otolaryngology, Head and Neck Surgery (de Almeida), Princess Margaret Hospital, University of Toronto, Toronto, Ont.; Department of Medicine (Guyatt), McMaster University, Hamilton, Ont.; Institute for Better Health and Division of Critical Care (Sud), Department of Medicine, Trillium Health Partners, University of Toronto, Mississauga, Ont.; Facial Rehabilitation (Dorion) and Department of Otolaryngology Head and Neck Surgery (Chen), Sunnybrook Health Sciences Centre, Toronto, Ont.; Department of Clinical Neurosciences, Hotchkiss Brain Institute (Hill), and Department of Clinical Neurosciences, Faculty of Medicine (White), University of Calgary, Calgary, Alta.; Department of Family Medicine (Kolber), University of Alberta, Peace River, Alta.; Department of Surgery (Lea, Westerberg), Division of Otolaryngology – Head and Neck Surgery, University of British Columbia, Vancouver, BC; St. Paul’s Rotary Hearing Clinic (Lea, Westerberg), Vancouver, BC; Back in Action Physiotherapy (Loong), Markham, Ont.; patient with Bell palsy (Somogyi), Toronto, Ont.; Division of Otolaryngology – Head and Neck Surgery, University of Toronto (Chen), Toronto, Ont.
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  • Management of Bell Palsy
    Ross E. Harrison
    Posted on: 12 September 2014
  • Posted on: (12 September 2014)
    Management of Bell Palsy
    • Ross E. Harrison, anesthetist (retired)

    I read the article by deAlmeida et al.and found it very informative. I believe it is generally accepted that most cases of Bell Palsy are related to virus induced inflamation of the facial nerve, however there are a few cases which are related to acute otitis media, which is often bacterial. I personally have been involved, as an anesthetist, in situations when urgent myringotomy has brought about rapid resolution of early B...

    Show More

    I read the article by deAlmeida et al.and found it very informative. I believe it is generally accepted that most cases of Bell Palsy are related to virus induced inflamation of the facial nerve, however there are a few cases which are related to acute otitis media, which is often bacterial. I personally have been involved, as an anesthetist, in situations when urgent myringotomy has brought about rapid resolution of early Bell Palsy.

    I mention this only to remind the front-line physician that such a situation is possible.

    Ross E. Harrison MD, FRCP

    Conflict of Interest:

    None declared

    Show Less
    Competing Interests: None declared.
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Canadian Medical Association Journal: 186 (12)
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Management of Bell palsy: clinical practice guideline
John R. de Almeida, Gordon H. Guyatt, Sachin Sud, Joanne Dorion, Michael D. Hill, Michael R. Kolber, Jane Lea, Sylvia Loong Reg, Balvinder K. Somogyi, Brian D. Westerberg, Chris White, Joseph M. Chen, Bell Palsy Working Group, Canadian Society of Otolaryngology – Head and Neck Surgery and Canadian Neurological Sciences Federation
CMAJ Sep 2014, 186 (12) 917-922; DOI: 10.1503/cmaj.131801

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Management of Bell palsy: clinical practice guideline
John R. de Almeida, Gordon H. Guyatt, Sachin Sud, Joanne Dorion, Michael D. Hill, Michael R. Kolber, Jane Lea, Sylvia Loong Reg, Balvinder K. Somogyi, Brian D. Westerberg, Chris White, Joseph M. Chen, Bell Palsy Working Group, Canadian Society of Otolaryngology – Head and Neck Surgery and Canadian Neurological Sciences Federation
CMAJ Sep 2014, 186 (12) 917-922; DOI: 10.1503/cmaj.131801
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