Abstract: Aim: This study aimed to compare the effectiveness of Acyclovir combined with corticosteroid therapy versus corticosteroid therapy alone in the treatment of idiopathic facial nerve palsy (Bell’s palsy) in terms of recovery rates, time to recovery, patient satisfaction, and incidence of complications.

Materials and Methods: A prospective, randomized, and comparative clinical trial was conducted with 100 patients diagnosed with idiopathic facial nerve palsy within 72 hours of symptom onset. Patients were randomly assigned into two groups: Group A received oral Acyclovir (400 mg five times daily) for 10 days combined with oral Prednisolone (1 mg/kg/day) for 10 days followed by a taper, while Group B received oral Prednisolone (1 mg/kg/day) for 10 days followed by a taper. Recovery was assessed at 2, 4, and 12 weeks using the House-Brackmann (HB) grading scale. Secondary outcomes included time to recovery, patient satisfaction, and adverse events. Data were analyzed using SPSS version 25.0, and a p-value <0.05 was considered statistically significant.

Results: Baseline characteristics, including age, gender, and comorbidities, were similar between the groups. At 12 weeks, recovery rates (HB Grade I/II) were significantly higher in Group A (96%) compared to Group B (80%; p = 0.01). Group A also demonstrated faster recovery, with a mean recovery time of 4.2 ± 1.5 weeks compared to 5.6 ± 2.0 weeks in Group B (p = 0.01). Patient satisfaction was higher in Group A, with a mean score of 8.5 ± 1.2 versus 7.3 ± 1.5 in Group B (p = 0.01). Complications were minimal and comparable between the groups.

Conclusion: Acyclovir combined with corticosteroid therapy is more effective than corticosteroids alone in the treatment of idiopathic facial nerve palsy. It significantly improves recovery rates, accelerates recovery time, and enhances patient satisfaction without increasing adverse events. These findings support the use of antiviral therapy as an adjunct to corticosteroids, particularly when initiated early.