[Bell's palsy: different doctor, different care?]

OBJECTIVE: To compare the diagnostic work-up and treatment strategy of Bell's palsy by: general practitioners (GPs); ear, nose and throat (ENT) specialists; and neurologists in the Netherlands.

DESIGN: Cross-sectional survey.

METHOD: GPs, ENT specialists and neurologists were asked to participate in an online survey on the diagnosis and treatment of Bell's palsy. Results per specialty were analysed using descriptive statistics and chi-squared test.

RESULTS: A total of 415 clinicians participated, including 149 GPs, 123 ENT specialists, and 143 neurologists. The answers from the three disciplines showed significant differences concerning history taking, physical examination, alarm symptoms, treatment strategy and follow-up. ENT specialists more frequently asked about hearing loss (90%), whereas neurologists enquired about weakness in arms and legs (62%). GPs less often ask about tick bites than clinicians in ENT and neurology, respectively (36% vs. 89% and 71%). Neurologists rarely performed otoscopy (21%), but more frequently tested eye movements (78%) than GPs (33%) and ENT specialists (20%). Compared to GPs and neurologist, ENT specialists more frequently reported the supplementation of Prednisone treatment with antiviral agents (45% vs. 9% and 6 % resp.). Furthermore, the time interval to the follow-up visit varied strongly between clinicians, ranging between a few days to six weeks after the first clinic visit.

CONCLUSION: This study shows that the diagnostic work-up and treatment strategy for Bell's palsy in the Netherlands is highly dependent on the clinician's specialty. Despite the fact that equivalent guidelines are in place, GPs, ENT specialists and neurologists gave different answers to questions concerning diagnostics and treatment. This finding suggests that more attention should be paid to the implementation of and adherence to the multidisciplinary guideline for Bell's palsy.