Surgical treatment of Bell's palsy: current attitudes.

OBJECTIVES/HYPOTHESIS To learn the current management of Bell's palsy among practicing otologists and neurotologists and to better define the role of surgical decompression of the facial nerve in the treatment of Bell's palsy. STUDY DESIGN Survey questionnaire. METHODS We conducted a survey of members of the American Otological Society and the American Neurotology Society to learn their current practices in the treatment of Bell's palsy. RESULTS Eighty-six neurotologists responded out of 334 surveys (26%). The majority of respondents obtain magnetic resonance imaging and electrical testing for new patients and treat with a combination of steroids and antiviral agents. More than two thirds of respondents would recommend surgery to patients who met the established electrophysiologic criteria (electroneuronography <10% normal, no spontaneous motor unit action potentials on electromyography within 10 days of onset of complete paralysis). However, only half believe that surgical decompression should be the standard of care, and only half would use a standard middle fossa approach. Lack of evidence was the most commonly cited reason for not recommending surgery. Several respondents wrote that they would leave the option of surgery to the patient. Most important, one third of neurotologists have not performed a surgical decompression for Bell's palsy in the last 10 years, and 95% perform less than one procedure per year. CONCLUSIONS Disagreement persists among practicing otologists about the role of surgical decompression for Bell's palsy. More convincing clinical evidence will be needed before there is widespread consensus regarding the surgical treatment of this condition.