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Clinical practice guideline: Bell's palsy. The evidence grades (A- D, X) and evidence- based statements (Strong Recommendation, Recommendation, Option, and No Recommendation) are defined at the end of the . Patient History and Physical Examination. Clinicians should assess the patient using history and physical examination to exclude identifiable causes of facial paresis or paralysis in patients presenting with acute- onset unilateral facial paresis or paralysis. Strong recommendation based on observational studies of alternative causes of facial paralysis and reasoning from first principles, with a preponderance of benefit over harm.

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Action Statement Profile. Aggregate evidence quality: Grade CLevel of confidence in evidence: High Benefit: Identification of other causes of facial paresis/paralysis, enabling accurate diagnosis; avoidance of unnecessary testing and treatment; identification of patients for whom other testing or treatment is indicated; opportunity for appropriate patient counseling Risks, harms, costs: None Benefit- harm assessment: Preponderance of benefit Value judgments: The Guideline Development Group (GDG) felt that assessment of patients cannot be performed without a history and physical examination and that it would not be possible to find stronger evidence, as studies excluding these steps cannot ethically be performed. Other causes of facial paresis/paralysis may go unidentified; a thorough history and physical examination will help avoid missed diagnoses or diagnostic delay. Intentional vagueness: None Role of patient preferences: None Exceptions: None Policy level: Strong recommendation. Differences of opinion: None Statement 2.

Laboratory Testing. Clinicians should not obtain routine laboratory testing in patients with new- onset Bell's palsy. Recommendation (against) based on observational studies and expert opinion with a preponderance of benefit over harm. Action Statement Profile. Aggregate evidence quality: Grade CLevel of confidence in evidence: High Benefit: Avoidance of unnecessary testing and/or treatment, avoidance of pursuing false positives, cost savings Risks, harms, costs: Potential missed diagnosis Benefit- harm assessment: Preponderance of benefit Value judgments: While the GDG felt that there are circumstances where specific testing is indicated in at- risk patients (such as Lyme disease serology in endemic areas), these patients can usually be identified by history.

Intentional vagueness: The GDG used the word routine to specify that under certain circumstances, laboratory testing may be indicated. Role of patient preferences: Small (there is an opportunity for patient education) Exceptions: None Policy level: Recommendation (against)Differences of opinion: None Statement 3. Diagnostic Imaging. Clinicians should not routinely perform diagnostic imaging for patients with new- onset Bell's palsy. Recommendation (against) based on observational studies with a preponderance of benefit over harm. Action Statement Profile. Aggregate evidence quality: Grade CLevel of confidence in evidence: High Benefit: Avoidance of unnecessary radiation exposure, avoidance of incidental findings, avoidance of contrast reactions, cost savings Risks, harms, costs: Risk of missing other cause of facial paresis/paralysis Benefit- harm assessment: Preponderance of benefit Value judgments: None Intentional vagueness: The word routine was used to indicate there may be some clinical findings that would warrant imaging.

Role of patient preferences: Small, but there is an opportunity for patient education/counseling Exceptions: None Policy level: Recommendation (against)Differences of opinion: None Statement 4. Oral Steroids. Clinicians should prescribe oral steroids within 7. Bell's palsy patients 1.

Strong recommendation based on high- quality randomized controlled trials with a preponderance of benefit over harm. Action Statement Profile. Aggregate evidence quality: Grade ALevel of confidence in evidence: High Benefit: Improvement in facial nerve function, faster recovery Risks, harms, costs: Steroid side effects, cost of therapy Benefit- harm assessment: Preponderance of benefit Value judgments: None Intentional vagueness: None Role of patient preferences: Small Exceptions: Diabetes, morbid obesity, previous steroid intolerance, and psychiatric disorders.

Pregnant women should be treated on an individualized basis Policy level: Strong recommendation. Differences of opinion: None Statement 5. Free Downloadable Financial Forms To Print. A. Antiviral Monotherapy.