Prognostic Value of Facial Nerve Excitability, Electroneurography, and Blink Reflex in Bell’s Palsy Patients at a Tertiary Care Hospital

Background: Bell’s palsy is the most common acute mononeuropathy. Although most patients recover, a subset experiences persistent facial weakness. Early identification of reliable prognostic indicators is essential for guiding management and counseling. Objective: To evaluate the prognostic value of electroneurography (ENoG) and blink reflex (BR) testing in predicting outcomes among patients with Bell’s palsy. Materials and Methods: A prospective observational study was conducted at Kasturba Medical College, Manipal, from August 2021 to January 2023. Seventy-three patients presenting within 14 days of symptom onset were enrolled. Baseline facial nerve conduction studies, ENoG (calculated as [CMAP amplitude of affected/unaffected side] × 100), and BR testing were performed. House–Brackmann (HB) grading was assessed at baseline and at 6–8 weeks’ follow-up. Multivariate logistic regression and receiver operating characteristic analyses were performed to identify the predictors of incomplete recovery (HB grade III–VI). Results: Of the 73 patients, 9 (12.3%) showed unfavorable ENoG values (<10%). At follow-up, 60 patients (82.2%) achieved good recovery (HB grade I–II). An ENoG value <10% was an independent predictor of poor outcome (odds ratio = 0.20, 95% confidence interval: 0.04–0.86, P = 0.037). BR abnormalities were seen in 95.9% but showed no significant association with recovery (P = 0.52). Conclusion: ENoG performed within the first 14 days of Bell’s palsy onset is a reliable early prognostic marker for incomplete recovery, whereas BR abnormalities, although common, lack predictive value. Early electrophysiological testing may facilitate timely risk stratification and individualized management.