To investigate the predictive value of combined blink reflex (BR) and electroneurography (ENoG) for the clinical prognosis of idiopathic facial nerve palsy (IFP). Methods: Patients with acute moderate to severe IFP (House-Brackmann [HB] grade ≥ 3) who presented within 7 days of onset at our hospital from May 2022 to May 2023 were prospectively included. All patients underwent BR and ENoG examinations 7～10 days after onset. The prognosis of facial nerve function was assessed using the HB grading system at the 3-month follow-up visit, with poor prognosis defined as an HB grade ≥ 3. Binary logistic regression analysis was used to evaluate the correlation between the combined BR and ENoG results and poor 3-month prognosis. Results: A total of 127 patients with acute moderate to severe IFP were included, among whom 11 patients (8.7% ) had a poor prognosis at the 3-month follow-up. Univariate analysis showed that compared with the good prognosis group, the poor prognosis group had a higher age and initial HB grade (both P<0.05). Compared with the group showing partial BR wave presence combined with mild ENoG decline on the affected side, the group with complete absence of BR waves combined with significant ENoG decline had a significantly increased risk of poor 3-month prognosis (OR 10.87, 95% CI 1.20～98.47, P=0.034). Receiver operating characteristic (ROC) analysis demonstrated that the combination of BR and ENoG could predict poor prognosis in IFP (AUC=0.765, P=0.011). Conclusion: Patients with IFP who exhibit both complete absence of BR waves and significant ENoG decline have a significantly increased risk of poor 3-month prognosis. This suggests that the combined application of BR and ENoG testing can accurately assess the clinical prognosis of IFP patients, providing an important basis for early intervention and individualized treatment.