Adherence to Bell’s Palsy Clinical Practice Guidelines: A Nationwide Retrospective Analysis

Introduction: The American Academy of Otolaryngology (AAO) clinical practice guidelines (CPG) for Bell’s palsy management strongly recommend initiating steroids within 72 hours of symptom onset while advising against the use of laboratory tests or imaging. Although adherence to these guidelines has been studied at single institutions, to our knowledge, no studies have utilized a large-scale nationwide database to evaluate guideline adherence.

Methods: Using TriNetX, a global EHR database, a retrospective study was conducted on patients diagnosed with Bell’s palsy (ICD code G51.0) between 2004 to 2024. Data collected included the administration of corticosteroids within 72 hours, the use of antivirals (valacyclovir or acyclovir), and whether imaging or serology testing was performed. Cohorts were analyzed before and after 2013, marking the publication of the AAO CPG.

Results: Prior to the CPG publication, 13,825 of 53,805 patients (25.7%) with Bell’s palsy received corticosteroids within 72 hours of diagnosis. After 2013, this figure increased significantly to 110,037 of 253,832 patients (43.4%) (p < 0.001).

Despite the guidelines advising against imaging and Borrelia Burgdorferi serology, both practices increased over time. The use of head or face MRI/CT rose from 288 of 53,805 patients (0.5%) before 2013 to 2,615 of 253,832 patients (1%) between 2013 and 2024 (p < 0.001). Similarly, serology testing increased from 2,231 of 53,805 patients (4.1%) before 2013 to 16,381 of 253,832 patients (6.5%) between 2013 and 2024 (p < 0.001). The use of antivirals, considered optional per the guidelines, also increased from 7,028 of 53,805 patients (13.1%) before 2013 to 59,502 of 253,832 patients (23.4%) between 2013 and 2024 (p < 0.001).

Conclusions: A greater percentage of patients with Bell’s palsy received steroid treatment within 72 hours of symptom onset after the CPG publication. However, providers continue to order imaging and labs which are not recommended by the CPG.