Nationwide Adherence to Bell's Palsy Clinical Practice Guidelines: Retrospective Analysis Using a Large‐Scale EHR Database

Objective This study aimed to evaluate nationwide adherence to American Academy of Otolaryngology–Head and Neck Surgery (AAO‐HNS) guidelines for Bell's palsy management using a large electronic health record (EHR) database. Study Design Retrospective cohort study. Setting U.S. Network in TriNetX. Methods A retrospective cohort study was conducted using the TriNetX global EHR database, identifying patients diagnosed with Bell's palsy (ICD‐10 code G51.0) from 2004 to 2024. Data collected included corticosteroid administration within 72 hours of diagnosis, antiviral use (valacyclovir or acyclovir), and the performance of imaging (computed tomography [CT]/magnetic resonance imaging [MRI] of the head or face) or Borrelia burgdorferi serologic testing. Outcomes were compared in cohorts before and after 2013, the year the AAO‐HNS guidelines were published. Results Steroid administration within 72 hours of diagnosis increased significantly after guideline publication, from 4798 (20.4%) patients before 2013 to 78,096 (33.8%) patients after 2013 ( P < .001). However, the use of non‐recommended practices also increased. Imaging use rose from 32.9% to 41.0% ( P < .001), and serologic testing for Borrelia increased from 1% to 5% ( P < .001). Antiviral use, considered optional by the guidelines, increased from 11.8% to 23.5% ( P < .001) over the same 72‐hour time period. Conclusion Following the publication of the AAO guidelines, early steroid use for Bell's palsy improved significantly. However, the concurrent rise in imaging and laboratory testing—practices explicitly discouraged by the guidelines—highlights ongoing gaps in adherence and suggests areas for further provider education and quality improvement.