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Do we need to give steroids in children with Bell’s palsy?
  1. Chetan Sandeep Ashtekar, Specialist Registrar,
  2. Manohara Joishy, Specialist Registrar,
  3. Rohit Joshi, Clinical Observer
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK; s.carley1btinternet.com

    Abstract

    A short cut review was carried out to establish whether steroids are indicated in children presenting with Bell’s palsy. A total of 60 papers were found using the reported search, of which three represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Chetan Sandeep Ashtekar, Specialist RegistrarChecked by Manohara Joishy, Specialist Registrar, and Rohit Joshi, Clinical Observer

    Three part question

    In [children with Bell’s palsy] does [giving oral steroids] [hasten recovery]?

    Clinical scenario

    You have been called to the emergency department to see a 6 year old boy with acute onset of weakness on the left side of the face. You diagnose it to be Bell’s palsy. You wonder if there is any evidence to use steroids in this situation.

    Search strategy

    Cochrane Edition 4 2004: Bell*palsy. PubMed February 2005: Bell’s palsy OR facial palsy AND steroids AND children. Limits: RCT, English, human and child <18 years.

    Search outcome

    Cochrane: three systematic reviews, one relevant (included only one RCT in children). PubMed: one RCT and one systematic review (included only one RCT in children). Limits excluding RCT: 60 hits, of which only one was directly relevant (table 3).

    Table 3

    Comment(s)

    Bell’s palsy (acute idiopathic facial nerve palsy) is a non-life-threatening disorder with important functional and psychosocial effects.1–3 The aetiology of Bell’s palsy remains unclear, but many consider it to be a reactivation to viral inflammation rather than ischaemia.4 Diagnosis depends on exclusion of known causes of facial palsy such as hypertension, trauma, tumour, acute otitis media, chronic ear disease, and chronic systemic neurological and metabolic disorders.5–7 The natural history of Bell’s palsy in children is thought to be benign with a tendency towards complete resolution in many cases within two months of the onset of the facial paralysis and by six months in most cases.1,2,8 However corticosteroids have been widely used in the treatment of Bell’s palsy, as it is believed to decrease the inflammation and oedema of the nerve sheath.

    Although many uncontrolled paediatric studies and case series suggested that steroids are beneficial, especially in cases with complete facial paralysis,9 other studies showed no benefit in the final outcome.10,11 We found only one randomised controlled trial done exclusively in children. This study reported a recovery rate of 80–90% in the first six months of the disease, which reached 100% by 12 months irrespective of the use of steroids.12 A recent systematic review found no positive evidence for the beneficial effects of corticosteroids in Bell’s palsy.13 Therefore they concluded that the routine use of corticosteroids for the treatment of paediatric Bell’s palsy is not recommended. Clearly there is a need for a well designed, adequately powered, multicentre randomised controlled trial to evaluate this issue.

    CLINICAL BOTTOM LINE

    Currently there is no evidence to recommend the use of corticosteroids for the treatment of Bell’s palsy in children.

    Report by Chetan Sandeep Ashtekar, Specialist RegistrarChecked by Manohara Joishy, Specialist Registrar, and Rohit Joshi, Clinical Observer

    REFERENCES

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