Bell’s Palsy

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What is Bell’s palsy?

Bell's palsy, the most common cause of facial paralysis, usually affects just one side of the face. The face appears to droop on one side, making your smile lopsided and one eye resists closing. Muscle weakness or paralysis starts suddenly and gets worse for about 48 hours. The cause is unknown but it’s believed that a viral infection makes the facial nerve swell or become inflamed. Risk increases if you are pregnant, diabetic, or sick with a cold or flu. It can happen at any age, and men and women are equally affected. It’s more likely to occur between the ages of 15 to 60.

Most people (75%) improve without treatment. Symptoms start to go away in about two weeks and most people fully recover in three to six months. Although it’s rare, Bell’s palsy can happen again, and some people continue to have symptoms for life. There is no known cure and most people get better without any treatment.

Causes

The exact cause of Bell’s palsy is unknown but it’s often associated with a viral infection. The nerve that controls facial muscles passes through a narrow bone channel in the skull before reaching the face. A viral infection can cause the nerve to become inflamed or swollen. In addition to face muscles, the facial nerve affects tears, saliva, taste and hearing. With some recurring cases, there’s a family history of recurring Bell’s palsy, which suggests a genetic link or cause.

These viruses have been linked to having Bell’s palsy:

  • Chickenpox and shingles (herpes zoster)
  • Cold sores and genital herpes (herpes simplex)
  • Cytomegalovirus infections
  • Flu (influenza B)
  • German measles (rubella)
  • Hand-foot-and-mouth disease (coxsackievirus)
  • Infectious mononucleosis (Epstein-Barr)
  • Mumps (mumps virus)
  • Respiratory illnesses (adenovirus)

Who’s at risk of developing Bell’s palsy?

People at higher risk of having Bell’s palsy include those with:

  • Pregnancy (most common at the end of pregnancy or a week after giving birth)
  • Viral infection
  • Diabetes
  • Herpes zoster
  • High blood pressure
  • Injury
  • Exposure to toxins
  • Lyme disease
  • Guillain-Barré syndrome
  • Sarcoidosis
  • Myasthenia gravis
  • Multiple sclerosis
  • HIV/AIDS infection

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Symptoms

What are the symptoms of Bell’s palsy?

Symptoms can range from mild to severe and include:

  • It’s common to feel discomfort behind the ear before facial weakness develops
  • Face feels stiff or pulled to one side
  • Inability to control or form facial expressions such as smiling, blinking, closing the eyelid
  • Weakness on one side of the face
  • Paralysis on one side of the face and/or loss of feeling in the face
  • Loss of ability to close the eye on the affected side
  • Difficulty eating and drinking without food falling out of the mouth on the affected side 
  • Twitching
  • Drooping eyelid or corner of mouth on the affected side
  • Drooling or producing excessive saliva
  • Dry eye or mouth, which can cause eye sores or infections
  • Excessive tearing in the eye
  • Impaired ability to taste
  • Pain around the jaw, or in the ear on the affected side
  • Increased sensitivity to sound on the affected side
  • Headache
  • Although rare, it can affect the nerves on both sides of the face

In severe cases, these complications may develop, although they are rare:

  • Irreversible damage to the facial nerve
  • Abnormal regrowth of nerves that can cause involuntary contraction of some muscles when trying to move other muscles (synkinesis), the eye on the affected side may close when you smile, for example 
  • Partial or complete blindness in the affected eye because it wouldn’t close, was very dry, or the cornea was scratched

Diagnosis

How is Bell’s palsy diagnosed?

It’s extremely important to see your doctor if you have any of the symptoms listed above. Some of these symptoms also occur with stroke, Lyme disease, infections or tumors. While there’s no specific test for Bell’s palsy, your doctor will perform a physical examination and ask you to make several facial expressions. 

If it’s not clear what’s causing your symptoms, your doctor may order these tests:

  • Electromyography (EMG) can confirm nerve damage and how severe it is.
  • Imaging scans (MRI or CT) can rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture.
  • Blood tests can determine if you have diabetes or Lyme disease.

Treatment

How is Bell’s palsy treated?

If there’s an underlying cause for your Bell’s palsy symptoms, such as an infection, that condition will be treated. Most people recover fully with no complications without any treatment. But each case is different and you may need one or more of these treatments:

  • If you cannot close your eye, it’s important to keep it from drying out, especially at night. You may need to use eye drops during the day and ointment at night. A moisture chamber helps keep the eye lubricated and protects the cornea from damage at night. It also helps to use a clean finger to close your affected eye frequently throughout the day. 
  • Medications such as corticosteroids can reduce inflammation and swelling; antiviral drugs may be used with corticosteroids in severe cases. If you’re having pain, over-the-counter pain relievers can help. A warm moist washcloth applied to the face several times a day also helps with pain and stiffness. 
  • Physical therapy can prevent shrunken and shortened muscles that cause permanent contractures.
  • Plastic surgery may be needed to correct facial nerve problems, make the face look more symmetrical, or restore facial movement. 

Some people have lingering symptoms after they have recovered. These can include long-term changes in taste, muscle spasms, eyelid spasms, long-term weakness in face muscles.

References

Johns Hopkins Medicine. (N.d.). Bell’s Palsy. Retrieved 10-27-21, {https://www.hopkinsmedicine.org/health/conditions-and-diseases/bells-palsy}
U.S. National Library of Medicine. (N.d.) Bell’s Palsy. MedlinePlus. Retrieved 10-27-21, {https://medlineplus.gov/bellspalsy.html}
Mayo Clinic. (April 2020). Bell’s palsy. Retrieved 10-27-21, {https://www.mayoclinic.org/diseases-conditions/bells-palsy/symptoms-causes/syc-20370028}
Mayo Clinic. (April 2020). Bell’s palsy Diagnosis and Treatment. Retrieved 10-27-21, {https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034}

Information

Medically reviewed by:

Dr. Desiree Levyim

Dr. Desiree Levyim is a board eligible neurologist in practice since 2020. She joins TeleMed2U in our mission to provide increased access to healthcare.

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