Bell Palsy

Bell's palsy is thought to be due to inflammation of the seventh cranial nerve, the facial nerve.

Bell's palsy tends to come on very suddenly, and one-sided facial weakness is typically maximal within 48 hours. Some people notice pain behind the ear a day or two before they notice any facial muscle weakness.

Other symptoms may include:

• decreased sense of taste
• dropping of the mouth at one corner
• hypersensitivity to sound in the ear on the same side as the facial weakness
• inability to blink or close the eye on the affected side

Bell's palsy is caused by a sudden breakdown of or damage to the nerve that supplies the muscles on one side of the face. Attacks often occur without a clear cause. The common cold sore virus, herpes simplex, is the likely cause of most cases of Bell's palsy. Other less common diseases associated with Bell's palsy include varicella zoster (chicken pox) virus, diabetes mellitus, Lyme disease, sarcoidosis, HIV, and leprosy.

At this time, no preventive strategies have been established.

Bell's palsy is diagnosed by a healthcare professional. The history and physical examination are the primary tools for diagnosis and the exclusion of other conditions that may mimic Bell's palsy. An MRI may be helpful to exclude a stroke or tumor involving the facial nerve and/or to confirm an abnormality of the seventh or facial nerve.

Electromyography or EMG in conjunction with a nerve conduction study may help to determine the degree of nerve damage. Blood tests may be ordered to look for rarer causes of Bell's palsy.

The prognosis for Bell's palsy is good. With or without treatment, most people begin to feel better within 2 weeks. About 80% recover completely within 3 months. In a few people, symptoms may last longer or even fail to disappear completely. Bell's palsy affects only one side of the face at a time. It is possible, though not usual, for Bell's palsy to occur again in the same person. Experts do not agree on the rate of recurrence, but at most it is only 10 to 15%.

Bell's palsy is not contagious. People who have it can return to work and their usual activities as soon as they feel ready.

It is important to consult a healthcare professional immediately once symptoms begin. Recent studies have shown that steroids are probably effective in treating this condition and relieving some of the symptoms. The antiviral drug, acyclovir, is possibly effective in improving facial function when used in combination with steroids.

Other treatments include:

• patching the affected eye shut
• using eye drops to prevent the eye from drying out

Preventing eye problems with eye drops and an eye patch is very important. Sometimes eye drops and steroids can have side effects. Any side effects should be reported to the healthcare professional.

With or without treatment, most people begin to improve significantly in 2 weeks. About 80% recover completely in 3 months.

Checking in with a healthcare professional during the period of facial paralysis is important to make sure there are no added complications. This condition can create anxiety because the palsy symptoms can look like a stroke. Any new or worsening symptoms should also be reported to the healthcare professional.