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Management of Bell's palsy in children: an audit of current practice, review of the literature and a proposed management algorithm
  1. Amir Saam Youshani1,
  2. Bimal Mehta2,
  3. Katharine Davies3,
  4. Helen Beer3,
  5. Sujata De3
  1. 1Department of Otolaryngology, Salford Royal NHS Foundation Trust, Salford, UK
  2. 2Department of Accident & Emergency, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  3. 3Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Sujata De, Department of Otolaryngology, Alder Hey Children's NHS Foundation Trust, Eaton Road, West Derby, Liverpool L12 2AP, UK; Su.De{at}alderhey.nhs.uk

Abstract

Objective We carried out a complete audit cycle, reviewing our management of paediatric patients with Bell's palsy within 72 h of symptom onset. Our protocol was published after the initial audit in 2009, and a re-audit was carried out in 2011. We aimed to improve our current practice in accordance with up-to-date evidence-based research on the use of steroids and antivirals.

Patients and methods A total of 17 patients were included in the first cycle, but only eight patients met our inclusion and exclusion criteria for the re-audit. We assessed documentation of House–Brackmann (HB) grade on presentation, initial treatment, follow-up and recovery.

Results The first cycle revealed inconsistent management with steroids (41%), antivirals (6%), steroids and antivirals (6%) or nothing at all (47%). In addition, only 65% of patients were followed-up in the ear, nose and throat (ENT) clinic. Our management protocol was published in 2010, and a re-audit was completed. Our results showed 100% compliance with steroid treatment and 100% follow-up with the ENT team. A thorough literature review revealed some additional benefit from the use of antivirals.

Conclusions At present there is insufficient evidence to discount the use of steroids and antivirals. Therefore, with our new management protocol, we recommend the use of steroids in patients presenting within 72 h of symptom onset, and antivirals for patients with a HB grade of IV or higher.

  • Audit
  • ENT
  • Paediatric Emergency Med
  • Clincial Management
  • Teaching

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