The Present Status of Therapy of Bell's Paralysis: A Critical Evaluation

The etiology of Bell's paralysis is yet unknown, and is likely to be multiple. The vast majority of patients suffering from Bell's paralysis recover spontaneously, and a certain number do not recover regardless of treatment, nor is there uniformity in the opinion as to what constitutes a full recovery. No investigation has as yet demonstrated beyond a reasonable doubt that any given medical treatment will alter the course of Bell's paralysis under any circumstance or prevent permanent partial or total denervation. At the present time, surgical decompression is the only treatment that deserves serious consideration; however, after a period of great enthusiasm, even surgical decompression is becoming more and more controversial. The evaluation of decompression in Bell's paralysis is as difficult as any other form of treatment. The two formidable problems are: 1) How and when are we able to recognize those cases which will degenerate? 2) How can we determine whether those cases showing evidence of degeneration will not recover spontaneously? The assumption that surgical decompression will prevent denervation has yet to be proven. The nerve excitability test as used in clinical practice is a very crude test and gives only the most rudimentary information of the functional status of the facial nerve. Tests describe a situation at a given moment and have no prognostic significance. Neither the opponents nor the proponents of decompression have been able to prove their point, and the value of decompression remains in doubt. Both a conservative and a more aggressive attitude have justification. Very extensive clinical investigations are required to prove or disprove the value of decompression in Bell's paralysis.