Evaluating Treatment Patterns in Bell’s Palsy Using Nationwide Employer- Sponsored Healthcare Claims

CLINICAL QUESTION

How closely do real-world prescribing patterns for Bell’s palsy align with the American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) guideline-recommended steroid and steroid–antiviral therapy?

BOTTOM LINE

Across a national cohort of 66,708 adults with Bell’s palsy, 51.9% received guideline-recommended steroid therapy within 72 hours, while 44.7% received no medication at all. Antiviral monotherapy, discouraged by AAOHNS guidelines, was used in 3.4% of cases. Substantial demographic and regional variation were observed in treatment selection.

BACKGROUND: High-dose corticosteroids initiated within 72 hours remain the standard of care for Bell’s palsy, with antivirals recommended only as adjuncts. Real-world prescribing practices vary widely across settings, and the relative use of steroids versus combination therapy is not well characterized. This study evaluated national treatment patterns to better understand adherence to guideline recommendations.

STUDY DESIGN: Retrospective cohort analysis of MarketScan commercial and Medicare supplemental claims (2013- 2020). Adults with idiopathic Bell’s palsy and one year or more of continuous enrollment were included. Treatment categories included steroid monotherapy, steroid–antiviral combination therapy, antiviral monotherapy, or no treatment.

SETTING: Nationwide, employer-sponsored outpatient insurance claims encompassing more than 100 million covered individuals

SYNOPSIS: The study included 66,708 adults diagnosed with Bell’s palsy. Overall, 44.7% received no pharmacologic therapy. Among treated patients, 34.1% received combination steroid–antiviral therapy, 17.8% received steroid monotherapy, and 3.4% received antivirals alone. Guideline-concordant steroid therapy within 72 hours was delivered in 51.9% of all cases, with 94.6% of treated patients initiating steroids on the index date. Treatment selection varied significantly by demographics, region, and clinical presentation. Men had higher odds of receiving combination therapy, whereas women and older adults were more likely to receive steroid monotherapy. Patients in the South and West were more likely to receive combination therapy than those in the Northeast. Certain presenting symptoms influenced prescribing: Ear pain was associated with combination therapy, whereas hearing loss and loss of lacrimation were associated with monotherapy. The authors emphasize that nearly half of patients received no treatment—possibly reflecting mild presentations or spontaneous recovery, but also variability in access to care, point of presentation, and awareness of guidelines. Limitations include the lack of clinical severity measures, incomplete capture of prescriptions outside insurance, and the inability to track recovery. Despite these constraints, the findings demonstrate persistent inconsistencies in real-world Bell’s palsy management and widespread underuse of recommended steroid therapy.

CITATION: Ratna S, et al. Evaluating treatment patterns in Bell’s palsy using nationwide employer-sponsored healthcare claims. Laryngoscope. 2025;135:2756- 2762. doi: 10.1002/lary.32115.

COMMENT: This research demonstrates that only half of patients with acute Bell’s palsy in the U.S. receive recommended treatment with high-dose steroids, with or without an antiviral. This statistic is concerning since starting high-dose steroids within 72 hours of symptom onset improves chances that patients make a complete recovery.—Matthew Q. Miller, MD