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Nationwide Adherence to Bell's Palsy Clinical Practice Guidelines: Retrospective Analysis Using a Large-Scale EHR

Nicole Favre1, Ariel Harsinay1, Mattie Rosi-Schumacher1

  • 1Department of Otolaryngology-Head and Neck Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|January 22, 2026
PubMed
Summary
This summary is machine-generated.

Adherence to Bell's palsy guidelines improved steroid use but increased non-recommended imaging and testing. Further education is needed for better patient care and guideline compliance.

Keywords:
AAO guidelinesBell's palsyantiviral usecorticosteroid therapy

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Area of Science:

  • Neurology
  • Otolaryngology
  • Health Services Research

Background:

  • Bell's palsy is a common neurological disorder affecting facial nerves.
  • The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published guidelines in 2013 for its management.
  • Evaluating adherence to these guidelines is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To assess nationwide adherence to the AAO-HNS guidelines for Bell's palsy management.
  • To analyze trends in treatment practices before and after the 2013 guideline publication.
  • To identify areas for improvement in clinical practice.

Main Methods:

  • Retrospective cohort study using the U.S. TriNetX electronic health record database (2004-2024).
  • Identified patients with Bell's palsy (ICD-10 G51.0).
  • Collected data on corticosteroid, antiviral use, imaging, and serologic testing within 72 hours of diagnosis.

Main Results:

  • Early corticosteroid use significantly increased post-guidelines (20.4% to 33.8%, P<.001).
  • Use of non-recommended imaging (32.9% to 41.0%, P<.001) and Borrelia testing (1% to 5%, P<.001) also rose.
  • Optional antiviral use increased from 11.8% to 23.5% (P<.001).

Conclusions:

  • The AAO-HNS guidelines led to improved early steroid administration for Bell's palsy.
  • Increased utilization of discouraged imaging and laboratory tests indicates persistent adherence gaps.
  • Further provider education and quality improvement initiatives are necessary to enhance guideline compliance.