Adjunctive antiviral therapy
›Antivirals with steroids
›Consider for severe palsy
›House Brackmann V to VI
›Shared decision making
›Valacyclovir
›1000 mg PO three times daily for 7 days
›Renal dose adjustment required
›Acyclovir alternative
›400 mg PO five times daily for 10 days
›Adherence limitations
›Evidence framing
›Steroids high benefit for complete recovery
›Class I recommendation common in neurology guidelines
›Antiviral incremental benefit small and greatest in severe cases
›Class IIb recommendation reasonable
Ramsay Hunt syndrome pathway
›Herpes zoster oticus management
›Antiviral plus corticosteroid recommended
›Valacyclovir 1000 mg PO three times daily for 7 to 10 days
›Start as early as possible
›Prednisone regimen as above
›Use with antiviral
›Analgesia
›Acetaminophen weight based or standard dosing
›Avoid exceeding daily maximum
›NSAID if no contraindication
›GI and renal risk review
›ENT follow up
›Hearing symptoms or vertigo
›Urgent referral
Symptom control and rehab
›Pain control
›Acetaminophen
›650 to 1000 mg PO every 6 to 8 hours as needed
›Max 4000 mg per 24 hours
›Ibuprofen
›400 mg PO every 6 to 8 hours as needed
›Max 2400 mg per 24 hours typical
›Facial physical therapy
›Consider for severe palsy or prolonged recovery
›Guidance to avoid excessive forced exercises early
›Synkinesis management in chronic phase
›Specialist referral consideration
›Antibiotics
›Not indicated for idiopathic Bell palsy
›Use only if otitis media or other bacterial diagnosis present