Patient presents to us 3 days after bell's palsy what is the initial treatment for the patient ?

Ans. is 'a' i.e., Medical management Treatment of Bell's palsy Treatment of Bell's palsy is divided into three :- (1) Medical treatment, (2) Physical treatment, (3) Surgical treatment. 1) Medical treatment Prednisolone (steroid) is the drug of choice and is staed at initial visit. Initiation of therapy during first 24 hours of symptom confers a higher likelihood of recovery. Antiviral therapy (Acyclovir) is a newer adjunct in treating acute facial palsy of viral origin (both Bell's palsy and Ramsay hunt syndrome). Most surgeons these days advocate combination of steroids and antiviral drugs. 2) Physical treatment Physical treatment includes : - i) Eye care :- Aificial tear drops, ocular ointment and use of sunglasses to prevent eye complication due to dry eye. ii) Electric stimulation :- To maintain membrane conductivity and reduce muscle atrophy. If the patient of Bell's palsy is not responding to conservative treatment, electrodiagnostic study (electrophysiological study) should be done. Electrodiagnostic study includes, electromyography (EMG), Electroneurography (ENG), minimal excitibility test and maximal excitibility test. Surgery is reserved for those who meet electrodiagnostic (electrophysiological) study criteria or are worsening on medial treatment. 3) Surgical treatment Nerve decompression relieves pressure on the nerve fibers and thus improves the microcirculation of the nerve.Usually veical and tympanic segments of nerve are decompressed. However, some worker's suggest total decompression including labyrinthine segment. Decompression is done in cases who have a poor prognosis for complete recovery with medical therapy alone or in cases who do not respond to medical therapy after 8-12 weeks.