Randomised controlled trials (RCTs) that compared any type of corticosteroid therapy with combined treatment of corticosteroids plus any type of antiviral agent (using any dose, route or duration of therapy) for patients with unilateral facial nerve weakness of no identifiable cause were eligible for inclusion. Patients in eligible trials had to be seen within seven days of onset facial nerve weakness and therapy had to be started within seven days of onset. Eligible trials assessed patients’ clinical status at least three months after the initial onset of the disease and start of therapy. Trials that included patients with uncontrolled diabetes mellitus, peptic ulcer disease, suppurative otitis media, herpes zoster, multiple sclerosis, or systemic infection, or of pregnant or breastfeeding women were excluded. Trials were also excluded if their data overlapped with those of other trials; the trial with the more extensive sample size was considered to be eligible for inclusion.
The primary eligible outcome was complete recovery of facial motor function three months after initiation of therapy, and also assessment at four, six and nine months. Secondary outcomes were adverse events including: dizziness, dyspepsia, nausea, constipation, hunger, vomiting, insomnia, night sweats and other symptoms attributable to drug choice.
All the drugs in the included trials were administered orally; the corticosteroids used were prednisolone and deflazacort; the antiviral agents used were acyclovir and valacyclovir. Details of dosage and regime were reported. The mean palsy severity of the patients in the included trials (where reported) ranged from 3.0 to 15.0, scored on House and Brackmann facial nerve grading system. The mean age of included patients ranged from 30 to 50.4 years, and the mean proportion of males ranged from 45 to 65%. Where reported, therapy was started either within three days or seven days of diagnosis, and the duration of therapy ranged from nine to 23 days. Duration of follow-up ranged from three to nine months.
Two independent researchers were involved in study selection, with any disagreements resolved by discussion and consensus.