Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 17973

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : MC01 - MC04 Full Version

Acyclovir with Steroid and Steroid Alone in the Treatment of Idiopathic Facial Nerve Palsy: A Randomised Double-blinded Clinical Study from a Tertiary Care Centre, Chennai, India

Published: January 1, 2023 | DOI:
SR Karthika, K Priya, S Rajasekaran, D Balaji

1. Junior Resident, Deparment of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India. 2. Professor, Deparment of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India. 3. Professor and Head, Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India. 4. Assistant Professor, Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. K Priya,
Professor, Department of Otorhinolaryngology, Chettinad Academy of Research and Education, Chettinad Hospital and Research Institute, Rajiv Gandhi Salai, OMR, Kelambakkam, Chennai-603103, Tamil Nadu, India.


Introdutcion: Idiopathic palsy of facial nerve is an acute disease which causes lower motor neuron palsy characterised by facial asymmetry leads to psychological effects and limits one’s social life. Steroids are very effective in the management of Bell’s palsy. The usage of antiviral is still in debate due to the idiopathic aetiology of Bell’s palsy.

Aim: To evaluate the efficacy of acyclovir with steroid and steroid alone in the management of Bell’s palsy with respect to the recovery time.

Materials and Methods: The randomised double-blinded clinical study was conducted in the Department of Otorhinolaryngology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, from September 2021 to February 2022 among 100 patients with idiopathic facial nerve palsy. Patients were divided into two groups, 50 patients in each. One group treated with acyclovir (400 mg oral five times daily) and methylprednisolone (1 mg/kg/day), and other group treated with steroid alone. Both the groups received physiotherapy in the Department of Physiotherapy and taught about home facial exercises. The patients were on regular follow-up for six months to monitor the time of the recovery. House-Brackmann grading system was used for initial assessment and monitor the recovery of the patient. The improvement of House-Brackmann grade to I or II was considered a satisfactory recovery. The association between two groups were assessed by Chi-square test (χ2), repeated measures and paired t-test. The statistical significance was considered when p-value <0.05.

Results: Out of 100 patients, 52 patients were male and 48 were female, while the age range was 19-58 years. At two months, 43 (86%) patients recovered in the combination group and 41 (82%) in the steroid alone group (p-value=0.038). At six months, 48 (96%) patients recovered in the combination group and 42 (84%) in the steroid alone group (p-value=0.178). The overall recovery rate was higher in the combination group (96%) compared to steroid alone group (84%).

Conclusion: The combination of acyclovir with steroids in the treatment of Bell’s palsy has better recovery compared to steroid alone therapy.


Antiviral drug, House-brackmann grading system, Methylprednisolone

Idiopathic palsy of facial nerve affects 20-30 per 100000 persons per year and has a high healing rate of 70%. It affects both men and women equally (1). Nicolaus Friedreich postulated that paralysis a figure or the cause of facial nerve palsy is exposure to cold surrounding (2). It is a type of lower motor neuron palsy caused by an unknown aetiology, otherwise called Bell’s palsy. The causes may be ischaemia, immunology, and recently virus-induced (3). Herpes Simplex Virus (HSV), belonging to the family Herpes viridiae, is believed to be the cause of Bell’s palsy. Its reactivation in geniculate ganglion causes neural inflammation, cytotoxic oedema followed by obstruction of microcirculation in the fallopian canal (4). The HSV genes were isolated from geniculate ganglia, endoneural fluid, and postaural muscles (5). Other viruses like Epstein-Barr virus, Varicella zoster virus, and cytomegalo virus also cause facial nerve palsy.

Ram Say Hunt syndrome is caused by Varicella zoster virus. The characteristics are ear vesicles, acute facial nerve palsy sometimes involvement of vestibulocochlear nerve. It also occurs without skin lesions called Zoster sine herpete which resembles Bell’s palsy (6). Even though the recovery rate is high, 30% of the patients have the severe form of Bell’s palsy and they do not undergo complete recovery (7).

Pharmacological management and physiotherapy play a major role in the treatment and recovery of Bell’s palsy. Medical treatment includes immunosuppressants, antiviral, and antibiotics (8). Steroids are the mainstay of the treatment. Steroids have an anti-inflammatory property which reduces neural inflammation and oedema thereby, improving the facial nerve function (9). Kasle DA et al., analysed variations in the management of acute bell’s palsy and concluded that compared to neurologists, Otorhinolaryngologists prescribe higher doses of steroids, most frequently antivirals and rarely imaging (2).

Acyclovir, a bacteriostatic, is the most commonly prescribed antiviral drug. Acyclovir inhibits HSV Deoxyribonucleic Acid (DNA) polymerase, thus, blocking DNA replication (10). Because the HSV reactivation in the aetiology of Bell’s palsy, the combination of the antiviral drug with steroid is effective. Yeo SG et al., compared acyclovir (2400 mg/day) with steroid (methyl prednisolone 1 mg/kg/day) and steroid alone in the Bell’s palsy and found that the overall recovery rate is greater in the combination group (93.1%) compared to steroid alone group (85.1%), but statistically not significant (1). Hato N et al., administered oral prednisolone (60-40 mg/day) with valacyclovir (1000 mg/day) and steroid with placebo for five days, and found that the recovery rate is higher in the combination of steroid with valacyclovir group (95.7%) compared to steroid with placebo group (88.6%) (11). Yeo SG et al., compared the efficacy of acyclovir with famciclovir and concluded that famciclovir was helpful in treating the severe facial nerve palsy (3). Despite these evidences, some otorhinolaryngologists recommend a combination of acyclovir with steroids while others suggests steroids alone.

The present study aimed to compare the efficacy of acyclovir with steroids and steroids alone in patients with idiopathic facial palsy along with physiotherapy. The primary outcome was to measure the early and complete recovery of facial nerve function and the secondary outcome was the prevention of contractures.

Material and Methods

This randomised double-blinded clinical study was conducted in the Department of Otorhinolaryngology, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India, from September 2021 to February 2022. The Institutional Ethics Committee approval was obtained (IHEC-I/0007/21) from the Chettinad University.

Inclusion criteria: Patients belonging to both gender, age between 18-60 years with acute symptoms of facial nerve palsy without any underlying cause were included in this study.

Exclusion criteria: Patients with facial palsy due to other causes like abnormalities of brain, neoplasm, acute or chronic middle ear disease, temporal bone fracture, surgery, and patients with uncontrolled diabetes mellitus (random blood sugar more than 200 mg/dL), duodenal ulcer were excluded from this study. All these patients were excluded based on history, clinical examination and investigations. Acute and chronic middle ear diseases were excluded by performing otoendoscopy or microscopic examination, while neoplasms and temporal bone fractures were excluded based on the Computed Tomography (CT) imaging of temporal bone.

Sample size calculation: The superiority margin was 0.05 (i.e., δ=0.05) and the true difference in mean between treatment groups was 1 (i.e., d=1) with a standard deviation of 1.8 (1). For achieving an 80% power (i.e., 1-β=0.8) at the 5% level of significance (i.e., α=0.05) with equal allocation (i.e., k=1), the sample size for treatment agents and the active control were 50 in each group (N=100).

After obtaining informed consent, detailed history of the symptoms, duration, and characteristics were taken. Thorough clinical examination including general and systemic examination along with ear, nose, and throat examination were carried out. Grading of facial nerve palsy was done using the House-Brackmann grading system (12).

Study Procedure

Patients with Bell’s palsy were divided randomly into two equal study groups. Randomisation was done using a systematic sampling method. Every odd number was randomised to steroid with acyclovir group whereas even numbers were assigned to steroid alone group.

• Acyclovir with steroid (n=50): Patients were treated with acyclovir and steroid (1 mg/kg/day).
• Steriod alone (n=50): Patients were treated only with Methylprednisolone (1 mg/kg/day).

The dose for Acyclovir was 400 mg oral five times daily and methylprednisolone was 1 mg/kg/day. All the patients were tested for random blood sugar levels before prescribing methylprednisolone. Capillary blood sugar levels were measured by glucometer at the time of presentation and all the patients with facial palsy had normal random blood sugar (below 200 mg/dL). Both groups received physiotherapy, which included galvanic electrical stimulation, facial massage in the Department of Physiotherapy while they came for review. The patients were taught facial expression exercises to practice in their home. Patients were asked to come for review after one week for reassessment. After that, they were followed regularly at two month and six month (Table/Fig 1).

House-Brackmann grading was used for monitoring the recovery of facial nerve palsy (13) (Table/Fig 2). House-Brackmann grades of I or II were considered as complete recovery of facial palsy, and grade III or IV as partial recovery.

Statistical Analysis

Statistical analysis was carried out using Statistical Package for the Social Sciences (SPSS) version 26.0 and Microsoft excel software. The tests used are frequency tables and descriptive statistics. The association between two groups were assessed by Chi-square test (χ2), repeated measures and paired t-test. The statistical significance was considered when p-value <0.05.


This study included 100 patients, of which 52 were males and 48 were females. The age group was 19-58 years, with mean age 35.28 years (Table/Fig 3). During the first visit, majority of the patients belonged to grade III (n=16) and grade IV (n=18) in the acyclovir with steroid group; and grade III (n=24) and grade IV (n=18) in the steroid alone group (Table/Fig 4).

At the end of two months, 43 (86%) patients recovered completely in acyclovir with steroid group (Table/Fig 4) and 41 (82%) patients recovered completely in the steroid alone group (p-value=0.038). At the end of six months, 48 (96%) patients recovered completely in the the acyclovir with steroid group and 42 (84%) patients recovered completely in the other (p-value=0.178).

The combination of acyclovir with steroid in the treatment of Idiopathic facial palsy showed early recovery compared to steroid alone and also prevents the contractures of facial muscles (Table/Fig 5).


Steroids, vasodilators, and blood circulation supplements are effective in the treatment of facial palsy (7). Methylprednisolone plays a major role in the early recovery and prevention of synkinesis. It produces anti-inflammatory response by preventing release of proinflammatory mediators like prostaglandins and leukotrienes through indirect inhibition of phospholipase (14).

The use of antiviral drugs in the recovery of facial palsy is still debatable. The most commonly used antiviral drug is acyclovir which blocks Deoxyribonucleic Acid (DNA) replication by inhibiting Herpes Simplex Virus (HSV) DNA polymerase (10). The present study aimed to compare the efficacy of acyclovir with steroid combination and steroid alone in the treatment of idiopathic facial palsy in terms of complete early recovery and prevention of complications. At the end of the study, the combination of acyclovir with steroids showed complete early recovery of idiopathic facial nerve palsy and fewer complications when compared to steroids alone.

The addition of antiviral drugs such as acyclovir, valacyclovir, and famciclovir with oral steroids aided in the early and higher recovery rate when compared to oral steroids alone. The most commonly used antiviral was acyclovir and its dosage ranges from 1000-2400 mg/day for 5 days. The least effective dose of acyclovir was 1000 mg/day. The other antivirals used are famciclovir (750 mg/day for 7 days) and valacyclovir (1000 mg/day for 5 days) (Table/Fig 6) (1),(3),(11),(15),(16),(17),(18),(19). The most common side effects of oral antiviral drugs are headache, nausea, and malaise, but the present study patients did not report any side-effects (14).

The current study showed the combination of acyclovir with oral prednisolone in the treatment of idiopathic facial palsy aided in early and complete recovery of facial weakness compared to steroids alone while patients receiving physiotherapy at the end of two months.


There are newer antiviral drugs available on the market nowadays like famciclovir, valacyclovir, etc., which have higher oral bioavailability with excellent efficacy. This study only compared the efficacy of acyclovir with steroids.


The present study compared the two groups i.e, acyclovir with steroid and steroid alone in the management of idiopathic facial nerve palsy and on regular follow-up for six months to observe the early recovery of facial palsy. There was complete and early recovery of Bell’s palsy while using acyclovir with steroid, compared to steroid alone along with physiotherapy. Future studies are recommended to evaluate the efficacy of various available antivirals and other modalities of treatment in Bell’s palsy for the better outcome.


Yeo SG, Lee YC, Park DC, Cha CI. Acyclovir plus steroid vs steroid alone in the treatment of Bell’s palsy. Am J Otolaryngol. 2008;29(3):163-66. [crossref] [PubMed]
Kasle DA, Torabi SJ, Savoca E, Tower JI, Hildrew D. Variations in the management of acute Bell’s palsy. Am J Otolaryngol. 2020;41(1):102299. [crossref] [PubMed]
Kim HJ, Kim SH, Jung J, Kim SS, Byun JY, Park MS, et al. Comparison of acyclovir and famciclovir for the treatment of Bell’s palsy. Eur Arch Otorhinolaryngol. 2016;273(10):3083-90. [crossref] [PubMed]
Baugh RF, Basura GJ, Ishii LE, Schwartz SR, Drumheller CM, Burkholder R, et al. Clinical practice guideline: Bell’s palsy. Otolaryngol Head Neck Surg. 2013;149(3_suppl):S1-27. [crossref] [PubMed]
Shokri T, Saadi R, Schaefer EW, Lighthall JG. Trends in the treatment of Bell’s palsy. Facial Plast Surg. 2020;36(05):628-34. [crossref] [PubMed]
Furuta Y, Ohtani F, Mesuda Y, Fukuda S, Inuyama Y. Early diagnosis of zoster sine herpete and antiviral therapy for the treatment of facial palsy. Neurology. 2000;55(5):708-10. [crossref] [PubMed]
Austin JR, Peskind SP, Rice DH, Austin SG. Idiopathic facial nerve paralysis: A randomised double blind controlled study of placebo versus prednisone. Laryngoscope. 1993;103(12):1326-33. [crossref] [PubMed]
Diels HJ, Beurskens C. Neuromuscular retraining: Non-surgical therapy for facial palsy. The facial nerve. New York, NY: Thieme. 2014:205-12.
Furuta Y, Fukuda S, Chida E, Takasu T, Ohtani F, Inuyama Y, et al. Reactivation of herpes simplex virus type 1 in patients with Bell’s palsy. J Med Virol. 1998;54(3):162-66. 3.0.CO;2-3>[crossref]
Wagstaff AJ, Faulds D, Goa KL. Aciclovir. A reappraisal of its antiviral activity, pharmacokinetic properties and therapeutic efficacy. Drugs. 1994;47(1):153-05. [crossref] [PubMed]
Hato N, Yamada H, Kohno H, Matsumoto S, Honda N, Gyo K, et al. Valacyclovir and prednisolone treatment for Bell’s palsy: A multicenter, randomised, placebo-controlled study. Otol Neurotol. 2007;28(3):408-13. [crossref] [PubMed]
Athanasios (Thanos) B Jiang D, Gleeson M. Disorders of the facial nerve. Scott- Brown’s Otorhinolaryngology Head and Neck Surgery 7 ed. Vol. 3, 2008.
Kawaguchi K, Inamura H, Abe Y, Koshu H, Takashita E, Muraki Y, et al. Reactivation of herpes simplex virus type 1 and varicella-zoster virus and therapeutic effects of combination therapy with prednisolone and valacyclovir in patients with Bell’s palsy. Laryngoscope. 2007;117(1):147-56. [crossref] [PubMed]
Tripathi KD. Essentials of Medical Pharmacology. 8 th edition, Jaypee Brothers Medical, 2018.
Hato N, Matsumoto S, Kisaki H, Takahashi H, Wakisaka H, Honda N, et al. Efficacy of early treatment of Bell’s palsy with oral acyclovir and prednisolone. Otol Neurotol. 2003;24(6):948-51. [crossref] [PubMed]
Numthavaj P, Thakkinstian A, Dejthevaporn C, Attia J. Corticosteroid and antiviral therapy for Bell’s palsy: A network meta-analysis. BMC neurology. 2011;11(1):01-10. [crossref] [PubMed]
Gagyor I, Madhok VB, Daly F, Sullivan F. Antiviral treatment for Bell’s palsy (idiopathic facial paralysis). Cochrane Database of Systematic Reviews. 2019;9(9):CD001869. Doi: 10.1002/14651858.CD001869.pub9. [crossref] [PubMed]
Kim Y, Doo JG, Chon J, Lee JH, Jung J, Lee JM, et al. Steroids plus antiviral agents are more effective than steroids alone in the treatment of severe Bell’s palsy patients over 40 years of age. Int J Immunopathol Pharmacol. 2021;35:20587384211042124. [crossref] [PubMed]
Kang HM, Jung SY, Byun JY, Park MS, Yeo SG. Steroid plus antiviral treatment for Bell’s palsy. J Intern Med. 2015;277(5):532-39. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/56306.17201

Date of Submission: Mar 12, 2022
Date of Peer Review: Apr 26, 2022
Date of Acceptance: Jul 21, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Mar 25, 2022
• Manual Googling: Jul 15, 2022
• iThenticate Software: Jul 19, 2022 (18%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)