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Objective   The effectiveness of the combination of steroids and antiviral agents in the treatment of Bell’s palsy remains unclear. This study evaluated the therapeutic effect of combination therapy in severe Bell’s palsy patients and assesses specific conditions under which combination therapy is more effective than steroids alone.Methods   From January 2005 to December 2019, the records of 1710 Bell’s palsy patients who visited Kyung Hee University Hospital were reviewed retrospectively. Of these, 335 (19.6%) patients were diagnosed with severe Bell’s palsy, with 162 patients treated with steroids alone and 173 patients treated with combinations of steroids and antiviral agents. The outcomes of treatment were assessed using the House–Brackmann (H-B) grade according to age, sex, hypertension, diabetes, and obesity.Results   The favorable recovery rate was significantly higher in severe Bell’s palsy patients who were treated with combinations of steroids and antiviral agents than with steroids alone (78.0% vs. 66.7%, p = 0.020). Subgroup analysis showed that combination therapy resulted in significantly higher recovery rates than steroids alone in patients aged ≥40 years (77.5% vs. 64.1%, p = 0.023) and in those without hypertension (75.8% vs. 63.3%, p = 0.044) and diabetes (79.7% vs. 65.5%, p = 0.007).Conclusion   Combination therapy with steroids and antiviral agents resulted in significantly higher favorable recovery rates than steroids alone in severe Bell’s palsy patients. Combination therapy was particularly more effective than steroids alone in patients aged ≥40 years and in patients without hypertension and diabetes.

Steroids plus antiviral agents are more effective than steroids alone in the treatment of severe Bell’s palsy patients over 40 years of age