Management of Bell's palsy in children: an audit of current practice, review of the literature and a proposed management algorithm. Issue 4 (6th December 2013)

• Record Type: Journal Article
• Authors: Youshani, Amir Saam; Mehta, Bimal; Davies, Katharine; Beer, Helen; De, Sujata
• Is Part Of: Emergency medicine journal. Volume 32:Issue 4(2015)
• Page Start: 274
• Page End: 280
• Publication Date: 2013-12-06
• Subjects: Audit -- ENT -- Paediatric Emergency Med -- Clincial Management -- Teaching; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2013-202385
• Languages: English
• ISSNs: 1472-0205

Abstract

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.