To the Editor, I have read with great interest the article on Bell's palsy andrelated blood count assessments by Atan et al. (1). The authorsfound that the neutrophil to lymphocyte ratio and platelet tolymphocyte are increased in patients with Bell's palsy. Thoughincreased compared to healthy controls, these ratios were notassociated with increased paralysis severity. The authors statethat these changes may be concordant with the pathogenesisbecause Bell's palsy is an inflammatory disease. However, from a hematological perspective, there are certainpoints that need to be emphasized to avoid misunderstandingand clinical confusion. The American Academy of Autolaryngology Head and Neck Surgery Foundation Clinical Practice Guideline on Bell's Palsy highly recommend that oral corticosteroids should be started within 72 hours of symptom onset (2).Corticosteroids are well known to show dramatic effects onblood cell counts. Specifically, the administration of glucocorticoids results in neutrophilic leukocytosis, accompanied by marked reductions in circulating eosinophils, monocytes andlymphocytes (3). These changes are so dramatic that a singledose of glucocorticoid leads to lymphopenia within 2 hoursof the dose, peaked at 6 hours and resolved by 24 hours (4).The increase in circulating neutrophil is due to impaired neutrophilic migration to sites of inflammation, enhanced releaseof cells from the bone marrow and inhibition of apoptosis.Regarding lymphocytes, glucocorticoids rapidly deplete circulating T cells by enhanced circulatory emigration, inhibitionof interleukin-2, a major T cell growth factor, impaired releaseof cells to the circulation and apoptosis induction (5). Numberof circulating B cells are also reduced but to a lesser extent.Although the major argument of this study is based uponaltered blood cell count in Bell's palsy, treatment is highly recommended to commence within 72 hours. The study presents no such treatment to achieve dramatic and rapid changes in white blood cell count. In a hematological perspective, these changes may be attributable to the effects of treatment (glucocorticoids) rather than the disease itself. The authors' not finding any relation between the severity of paralysis with the cell ratios, also support my assessment.Furthermore, in retrospective studies, the countenance andreliability of factors, which may confound the main finding, arenot easily managed. As stated as a retrospective study, derivation of the data leaves an obscure sensation in the reader's mind.In conclusion, I believe that this study, as presented to contribute to the literature with new findings should be consideredunder the information I have mentioned above.Ethics Committee Approval: N/A. Informed Consent: N/A. Peer-review: Externally peer-reviewed. Conflict of Interest: No conflict of interest was declared by the author. Financial Disclosure: The author declares that this study has received no financial support.