Facial paralysis treatment: South Korea updates guidelines on 'golden time'

Sudden facial paralysis, known as Bell's palsy or facial nerve palsy, can be a frightening experience, often leading individuals to suspect serious conditions like stroke. However, this condition, affecting 20 to 30 out of every 100,000 people annually, is relatively common and highly treatable if addressed promptly. A newly revised clinical guideline, released on the 16th anniversary of 'Facial Nerve Day' by the Korean Academy of Otorhinolaryngology and the Korean Society of Facial Nerve, underscores the critical importance of early intervention.

The revised '2026 Korean Clinical Practice Guideline for Facial Nerve Palsy' centers on three core principles: initiating treatment within 72 hours of symptom onset, accurately distinguishing Bell's palsy from stroke and other serious conditions, and diligently protecting the affected eye. Prompt medical attention is paramount, as delaying treatment can lead to permanent facial asymmetry or other lingering effects.

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If sudden pain behind the ear occurs, or if one eye cannot be closed well, or if water leaks from the mouth when drinking, one should not delay and visit an ENT or neurology department.

Recognizing the signs is the first step toward timely treatment. Common symptoms include the inability to fully close one eye, leakage of fluids from the mouth on the affected side when drinking, and a noticeable distortion of the mouth when smiling. Some individuals may also experience reduced taste sensation on the front of the tongue, dry eyes, or excessive tearing. Preceding these overt signs, some patients report a dull or sharp pain behind the ear, a feeling of stiffness in one side of the face, or twitching under the eye. These subtle warnings should not be ignored.

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Facial nerve palsy often shows good results for many patients with appropriate early response, but if the timing is missed, lifelong sequelae can remain.

Bell's palsy typically arises from inflammation or damage to the seventh cranial nerve, which controls facial muscles. This is often triggered by viral infections, particularly in individuals with weakened immune systems, exacerbated by factors like overwork, stress, and lack of sleep. While common myths suggest exposure to cold drafts, experts pinpoint lowered immunity leading to acute nerve inflammation as the primary cause. A significant challenge in managing this condition is that many patients delay seeking professional medical help, opting instead for unverified folk remedies.

The "golden hour" for treating facial nerve palsy is within 72 hours of symptom onset. During this critical window, high-dose steroids and, if necessary, antiviral medications are administered to reduce nerve inflammation and swelling. Failure to act within this timeframe can result in irreversible nerve damage, leading to persistent facial disfigurement or synkinesis, where involuntary movements occur, such as the eye closing when the mouth moves. As Dr. Lee Jong-dae, President of the Korean Society of Facial Nerve, emphasizes, "While a majority of patients experience positive outcomes with appropriate early intervention, missing the timing can result in lifelong sequelae." He urges individuals experiencing sudden ear pain, difficulty closing one eye, or mouth leakage to seek immediate care at an ENT or neurology clinic, rather than wasting precious time on unproven treatments.

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Rather than wasting time on unverified treatments, one should visit a specialized medical institution within 72 hours of symptom onset.