A recent study has highlighted the overutilization of imaging techniques in the diagnosis and management of Bell’s palsy, a condition characterized by sudden weakness in the muscles on one side of the face. Although imaging can sometimes provide valuable insights, it should be reserved for cases where clinical signs specifically warrant it. The research, conducted by a collaborative team of medical students and facial plastic surgeons from Mount Sinai Medical Center and a chief resident from Vanderbilt University Medical Center, marks the first nationwide analysis focusing on the use of imaging for this condition in the United States.
The findings are published in the journal The Laryngoscope, revealing that approximately 25% of patients diagnosed with Bell’s palsy underwent either a computed tomography (CT) scan or magnetic resonance imaging (MRI) within 30 days of their diagnosis. This practice contradicts the guidelines set forth by the American Academy of Otolaryngology–Head and Neck Surgery, which recommend against imaging in uncomplicated cases.
Examining Imaging Use and Patient Care
The retrospective study utilized data from two extensive healthcare databases: the MarketScan Commercial Claims and Encounters Database and the MarketScan Medicare Supplemental Database. Together, these databases encompass over 100 million patients, providing a comprehensive sample of the U.S. population. The analysis included data from 35,942 adult patients with continuous insurance coverage for at least one year following their initial Bell’s palsy diagnosis.
Researchers found that patients who underwent imaging were more likely to receive both antiviral and steroid treatments. This trend suggests that healthcare providers may be exercising caution in managing more severe cases. However, the study raises concerns about the unnecessary strain on healthcare resources and costs associated with the overuse of imaging.
According to the study’s lead author, Sujay Ratna, “Our findings underscore the importance of updating clinical guidelines and disseminating them across all specialties that care for these patients, not just otolaryngology.” The study advocates for prioritizing a thorough history and physical examination when diagnosing Bell’s palsy, ensuring that patients receive prompt treatment with corticosteroids within 72 hours of symptom onset.
Implications for Future Research
Bell’s palsy can be alarming for patients, as the symptoms may mimic those of a stroke. Nevertheless, when clinical evaluations are normal, the condition typically resolves spontaneously within three months. The study emphasizes that imaging should be reserved for cases where there are clear clinical indications of more serious conditions, such as cerebrovascular accidents.
The research highlights the need for initiatives aimed at aligning clinical practices with evidence-based guidelines. Moving forward, the authors intend to explore how their findings apply to populations without private insurance and to assess the influence of race and socioeconomic status on imaging trends related to Bell’s palsy.
Ratna expressed gratitude for the mentorship received throughout the research process, particularly from Dr. Mingyang Gray and Dr. Joshua Rosenberg at Mount Sinai, and Rahul Sharma, MD, at Vanderbilt University Medical Center. As healthcare systems worldwide strive to optimize patient care while managing costs, this study contributes valuable insights into the appropriate use of diagnostic imaging in managing Bell’s palsy, reinforcing the importance of evidence-based practice.
For more information, see Sujay Ratna et al, Nationwide Analysis of Head and Neck Imaging for Bell’s Palsy: Insights From Healthcare Claims, The Laryngoscope (2025). DOI: 10.1002/lary.70238.
