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Although most facial nerve paralysis is idiopathic (Bell’s palsy), all patients need to be seen by an ENT specialist to exclude other causes. These include ear pathology such as middle ear disease and cerebellopontine angle lesions.

An examination of the ear, parotid gland and cranial nerves should be performed. In addition an audiogram is necessary to exclude a sensorineural hearing loss that may indicate an acoustic neuroma.

Assessment of the degree of paralysis is helpful to document any change over a period of time.

Management of idiopathic Bell’s palsy
- Reassurance that 80 – 90% recover completely (may take up to 6 months).
- Systemic steroids unless contraindicated (prednisolone: 60mg./day reducing over a two week period).
- Eye protection particularly when outdoors and at night time.