Variations in the management of acute Bell's palsy

To identify presiding practices among neurotologists (ORL) in the care of acute Bell's palsy, and to compare them to neurologists' treatment patterns.

Cross-sectional survey study.

Neurotologists and neurologists.

Ninety-one responses to the survey were obtained. The majority of participants (87.9%) always prescribe steroids. ORL were more likely to prescribe higher doses (≥60 mg) than neurologists (89.7% vs. 58.0%) (p = 0.001). Anti-viral medication was initially prescribed by 46.2% of respondents (56.1% ORL vs. 38.0% neurologists; p = 0.085). An MRI was always ordered by 17 participants (18.7%), while an MRI was sometimes ordered by 45 participants (49.5%). ORL were not only more likely to always order an MRI (24.4% vs. 14.0%), but also more likely to never order an MRI (43.9% vs. 22.0%) (p = 0.009). Laboratory blood work was never ordered by 45.1% of respondents, with 70.7% of OTO and 24.0% of neurologists indicating that they would never order labs (p < 0.001).

ORL almost always prescribe steroids, prescribe antivirals around 50% of the time, and only sometimes obtain imaging for acute Bell's palsy. Compared to neurologists, ORL are more likely to order high dose steroids (≥60 mg), more commonly prescribe antivirals, and are less likely to order laboratory blood work. Regarding the treatment of acute Bell's palsy, there are discrepancies both within otolaryngology, and between otolaryngology and neurology, despite recently published guidelines from both specialties.