Analysis reveals overutilization of imaging in Bell's palsy

Bottom line: This study analyzes how imaging is used to diagnose and manage Bell's palsy, a condition that causes sudden weakness in the muscles on one side of the face, usually temporarily. Although diagnostic imaging can help rule out potential red flags or help providers understand the causes of a patient's symptoms, it should be used only when clinical signs warrant it. To the researchers' knowledge, no studies have explored this relationship in the context of Bell's palsy. By evaluating the current use of imaging in diagnosing and managing Bell's palsy, researchers aimed to ensure that practices emphasize optimal patient care while minimizing unnecessary health care costs.

For this research, Mount Sinai medical students and facial plastic surgeons collaborated with a chief resident from Vanderbilt University Medical Center's Department of Otolaryngology.

Why this study is unique: This study is the first of its kind to use nationwide analysis to examine how and when imaging is used to diagnose and manage Bell's palsy in the United States.

Why the study is important: This study helps assess whether current imaging practices for Bell's palsy align with evidence-based guidelines. Since Bell's palsy is typically diagnosed through a thorough history and physical exam, imaging is usually unnecessary for uncomplicated cases, and steroid treatment within 72 hours is recommended. This approach ensures patients receive prompt, effective care while avoiding unnecessary imaging, ultimately reducing health care costs.

How the research was conducted: For this retrospective study, data were collected from two databases: the MarketScan Commercial Claims and Encounters Database, which includes deidentified outpatient insurance claims for privately insured individuals in the United States, and the MarketScan Medicare Supplemental Database, which covers individuals enrolled in Medicare. Together, these databases provide data on more than 100 million patients, offering a representative sample of the U.S. population with employer-sponsored private insurance.

From that group, data from only 35,942 adult Bell's palsy patients with continuous insurance coverage for at least one year after their initial Bell's palsy diagnosis were included.

Results: From this analysis of just under 36,000 patients with Bell's palsy, roughly 25 percent had a CT (computed tomography) or MRI (magnetic resonance imaging) within 30 days of diagnosis, which is not aligned with the current guidelines published by the American Academy of Otolaryngology–Head and Neck Surgery. Researchers also found that patients who had imaging were more likely to receive both antiviral and steroid treatments, possibly because providers are taking extra precautions with more severe cases.

These findings highlight the overutilization of imaging, which increases costs and the strain on resources without providing significant diagnostic value in routine cases. This study emphasizes the need for initiatives to align clinical practice with evidence-based guidelines, promoting early treatment with corticosteroids and minimizing unnecessary imaging.

What this study means for patients: Bell's palsy can be a frightening diagnosis for patients, as the sudden facial paralysis that it causes can mimic the signs of a stroke. However, if the patient's history and physical exam are normal, Bell's palsy typically resolves on its own within three months and can be effectively treated with prompt steroid administration, without the need for imaging.

What this study means for doctors: While providers may order imaging to rule out potential red flags-such as cerebrovascular accidents or other cranial nerve deficits-it's essential that imaging is performed only when a patient's symptoms warrant it. The findings reinforce that clinicians should prioritize a thorough history and physical exam when diagnosing Bell's palsy and administer steroid therapy within 72 hours of symptom onset to ensure the best possible outcome for the patient.

What the next steps are for this work: This study used data focusing on patients with private insurance or Medicare. The next steps involve examining whether these findings hold for populations without private insurance and exploring how factors such as race and socioeconomic status may influence imaging trends for Bell's palsy.

Quotes: "This study sheds light on the possible overutilization of diagnostic imaging for Bell's palsy that is idiopathic-without a known cause-compared to the clinical guidelines," Mr. Ratna says. "Our findings underscore the importance of updating clinical guidelines and disseminating them across all specialties that care for these patients, not just otolaryngology. I'm grateful to my mentors, Drs. Mingyang Gray and Joshua Rosenberg at Mount Sinai, and to Rahul Sharma, MD, at Vanderbilt University Medical Center, for their mentorship and collaboration."