{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T00:35:46Z","timestamp":1789259746073,"version":"build-2803163510"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T00:00:00Z","timestamp":1679443200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>In 2013, the American Academy of Otolaryngology\u2010Head and Neck Surgery (AAO\u2010HNS) published guidelines for Bell's palsy (BP), including recommendations for workup, management, and specialist referral. Patients with BP often present to primary care; however, adherence to guidelines may vary by setting. This study sought to evaluate the management of patients with BP presenting to primary care, emergency department (ED), and urgent care settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary care center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective chart review of patients identified by diagnosis code for BP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 903 patients were included; 687 (76.1%) presented to ED, 87 (9.6%) to internal medicine, 77 (8.5%) to family medicine, and 52 (5.8%) to urgent care. On presentation, 804 (89.0%) patients were prescribed corticosteroids and 592 (65.6%) antiviral therapy. Steroid therapy ranged from 1 dose to greater than a 14\u2010day course, with 177 (19.6%) receiving an adequate duration of 10 days or greater. Referrals were provided to facial plastics and\/or otolaryngology for 51 patients (5.6%). For all comers, 283 (31.3%) had complete resolution, 197 (21.8%) had an incomplete resolution, 62 (6.9%) had persistent palsy, and 361 (40.0%) lost to follow\u2010up. In assessing the association between clinic setting and management, appropriate corticosteroid therapy (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01), imaging (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01), and eye care (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01) were statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Adherence to guidelines for BP management varies amongst providers. In our study cohort, 15.5% of patients received medical therapy in accordance with AAO\u2010HNS guidelines, and only 5.6% were referred to facial plastics. To facilitate more appropriate care, tertiary care institutions may benefit from system\u2010wide care pathways to manage acute BP.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.313","type":"journal-article","created":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T09:44:34Z","timestamp":1679478274000},"page":"858-864","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Management, Referral Patterns, and Outcomes in Bell's Palsy: A Single\u2010Institution 903 Patient Series"],"prefix":"10.1002","volume":"169","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7139-1502","authenticated-orcid":false,"given":"Sara W.","family":"Liu","sequence":"first","affiliation":[{"name":"Section of Facial Plastic and Microvascular Surgery Cleveland Clinic, Head and Neck Institute  Cleveland Ohio USA"},{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrell T.","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Mid\u2010Atlante Permanente Medical Group  Woodbridge Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Abramczyk","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Lerner College of Medicine  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen P.","family":"Hadford","sequence":"additional","affiliation":[{"name":"Section of Facial Plastic and Microvascular Surgery Cleveland Clinic, Head and Neck Institute  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7925-012X","authenticated-orcid":false,"given":"Dane J.","family":"Genther","sequence":"additional","affiliation":[{"name":"Section of Facial Plastic and Microvascular Surgery Cleveland Clinic, Head and Neck Institute  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Byrne","sequence":"additional","affiliation":[{"name":"Section of Facial Plastic and Microvascular Surgery Cleveland Clinic, Head and Neck Institute  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Fritz","sequence":"additional","affiliation":[{"name":"Section of Facial Plastic and Microvascular Surgery Cleveland Clinic, Head and Neck Institute  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0735-7614","authenticated-orcid":false,"given":"Peter J.","family":"Ciolek","sequence":"additional","affiliation":[{"name":"Section of Facial Plastic and Microvascular Surgery Cleveland Clinic, Head and Neck Institute  Cleveland Ohio 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