Bell’s palsy is a common presentation in Otolaryngology practice. The aim of the present study to find the etiology and management of patients with Bell's palsy presenting to the Department of Otolaryngology in a tertiary care hospital. Methods: This prospective cross-sectional study was carried out in the Department of ENT, Rajiv Gandhi Institute of Medical Sciences [RIMS], Adilabad from September 2017 to Jan 2019. A total of n=67 patients n=26 male and n=41 females were included in the study. After complete history and clinical evaluation an initial dose of oral prednisolone 60mg/day in three divided doses for 7 days followed by tapering off within the next five days by 10mg/day reduction in a single-dose regimen. Advised serial follow up at the end of 1^st, 2^nd, 3^rd and 6^th week followed by 3 months and 6 months. Results: The grading of facial paresis was carried as per House-Brackmann scale most of the patients n=33(49.25%) were detected with Grade II mild dysfunctions. Followed by moderate dysfunction grade III in n=15(22.39%). Grades IV and V having n=7(10.45%) each and grade VI in n=5(7.46%). The majority patients were given steroids n=36(53.73%) and steroids along with physiotherapy n=15(22.39%), NSAID n=21(31.34%), vitamin B12 n=22(32.84%) and antiviral were for n=10 (14.92%). Conclusion: The present study concludes that females are more commonly affected by Bell's palsy and the age group more affected is 30 - 40 years. Recurrence of Bell's palsy was also noted in some cases. Most of our patients responded to prednisolone and antiviral treatment, some were prescribed only steroids with physiotherapy. From our experience, we can assume that the treatment of Bell's palsy should be based on the etiology and needs of the patients and most of the cases will recover within acceptable limits.

Keywords: Bell’s palsy, Etiology, Management, Tertiary care hospital.

1. A Zandian, S Osiro, R Hudson, et al; The neurologist’s dilemma: A comprehensive clinical review of Bell’s palsy with emphasis on current management trends. Med Sci Monit 2014; 20:83-90.
2. Vlastou C. Facial paralysis. Microsurgery 2006; 26(4): 278-87.
3. Grogan PM, Gronseth GS. Practice parameter: Steroids, acyclovir, and surgery for Bell’s palsy (an evidence-based review): Report of the quality standards subcommittee of the American academy of neurology. Neurology 2001; 56(7): 830-36.
4. Ljøstad U, Økstad S, Topstad T, Mygland A, Monstad P. Acute peripheral facial palsy in adults. J Neurol 2005; 252(6): 672-76.
5. Döner F, Kutluhan S. Familial idiopathic facial palsy. Eur Arch Otorhinolaryngol 2000; 257(3): 117-19.
6. Rowlands S, Hooper R, Hughes R, Burney P. The epidemiology and treatment of Bell’s palsy in the UK. Eur J Neurol 2002; 9(1): 63-67.
7. Peitersen E. Bell’s palsy the spontaneous course 2,500 peripheral facial nerve palsies of different aetiologies. Acta Otolaryngol 2002; 549: 4-30.
8. De DJ Prim MP, Madero R, Marco S, Gavian J. Effect of atmospheric factors on the incidence of Bell’s palsy. Eur Arch Otorhinolaryngol 2002; 259(1):53-55.
9. Jabor MA, Gianoli G. Management of Bell's palsy. J La State Med Soc 1996; 148(7):279-83.
10. Adour KK, Hilsinger RL Jr, Callan EJ. Facial paralysis and Bell’s palsy: a protocol for differential diagnosis. Am J Otol 1985; (Suppl): 68-73.
11. Grogan PM, Gronseth GS. Practice parameter: Steroids, acyclovir, and surgery for Bell's palsy (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001; 56 (7):830-36.
12. House JW; Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93(2):146-47.
13. Stanley M, Ifeanyi UC, Zuwera S, Yunus OA, Theophilus D, Abiodun JO. Review of facial nerve palsy at a tertiary hospital in Maiduguri, Nigeria. American Journal of Health Research 2016; 4(4): 100-03.
14. Lamina S, Hanif S. Pattern of facial palsy in a typical Nigerian specialist hospital. African Health Sciences 2012; (4):514 – 17.
15. Batista KT. Facial paralysis: epidemiological analysis in a rehabilitation hospital. Rev. Bras. Cir. Plást. 2011; 26(4): 591-95.
16. Junior NA, Jorge Junior JJ, Gignon VF, Kitice AT, de Almeida Prado LS, Wolff Santos VG. Facial Nerve Palsy: Incidence of different etiologies in a tertiary ambulatory. Intl. Arch. Otorhinolaryngol., São Paulo 2009; 13(2):167-71.
17. Hohman MH, Hadlock TA. Etiology, diagnosis, and management of Facial palsy: 2000 patients at a facial nerve center. Laryngoscope 2014; 124: 283–293.
18. Katusic SK, Beard CM, Wiederholt WC, Bergstralh EJ, Kurland LT. Incidence, clinical features, and prognosis in Bell's palsy, Rochester, Minnesota, 1968-1982. Ann Neurol 1986; 20(5): 622-67.
19. Costa Apostolides, Michele M Carr. Assessment and management of idiopathic facial (Bell’s) Palsy: comparison of Nova Scotia family physicians and otolaryngologists. The Journal of Otolaryngology 2000; 29(1): 17-22.
20. Lane C. Management of ocular surface exposure. Br J Ophthalmol 2012;96(4): 471-72.
21. Brandenburg NA, Annegers JF: Incidence and risk factors for Bell’s palsy in Laredo, Texas: 1974–1982. Neuroepidemiology 1993; 12:313–325.
22. Accomando J, D’Agostino A, Adelman HM: An unusual manifestation of diabetes mellitus. Hosp Pract (Minneap) 1999; 34:39–40.
23. Paolino E, Granieri E, Tola MR, Panarelli MA, Carreras M: Predisposing factors in
    Bell’s palsy: a case-control study. J Neurol 1985; 232:363–65.
24. Shmorgun D, Chan WS, Ray JG: Association between Bell’s palsy in pregnancy and preeclampsia. Q J Med 2002; 95:359–62.
25. Loggie JM: Evaluation and management of childhood hypertension. Surg Clin North Am 1985; 65:1623–49.
26. Shapiro JL, Yudin MH, Ray JG: Bell’s palsy and tinnitus during pregnancy: predictors of pre-eclampsia? Three cases and a detailed review of the literature. Acta Otolaryngol 1999; 119:647–51.
27. Gilden DH. Clinical practice. Bell's Palsy. N Engl J Med. 2004; 351(13):1323-31.
28. Alberton DL, Zed PJ. Bell's palsy: A review of treatment using antiviral agents. Ann Pharmacother 2006; 40(10):1838-42.

Dr Yelma Bhooma Reddy

Sri Laxmi Residency, Flat No 102, Opp Govt Girls high school, Vidyanagar, Adilabad-504001, India