Bell’s Palsy

Bell’s palsy can occur in anyone of any gender and at any age, though can be found more commonly in the 15 to 45-year old age group. In the USA, it affects around 40,000 people annually.

Bell’s palsy is a neurological condition also known as acute idiopathic facial paralysis. During an episode of Bell’s palsy, the symptoms of one-sided weakness or paralysis in the face can be sudden and alarming. The exact cause of this condition is unknown, though it’s understood to be a problem with the facial nerve (cranial nerve 7). This nerve is responsible for facial movement and expression, taste, tear production, and sensitivity to noise.

Bell's Palsy

Symptoms of Bell’s Palsy

Injury or dysfunction to the facial nerve will result in specific symptoms that develop rapidly over a 48 to 72-hour period. Often, these symptoms will gradually improve on their own over a matter of a few weeks and many people are back to normal in around six months. However, some people will continue to experience a degree of permanent facial weakness. On the rare occasion, an episode of Bell’s palsy may reoccur after having resolved.

Symptoms can vary in severity. They include:

  • Sudden weakening or paralysis of the muscles on one side of your face
  • The facial structures of one side drooping, such as your eyebrow and mouth
  • Difficulty with facial expressions
  • Inability to close one eyelid properly
  • Drooling from one corner of the mouth
  • Headache
  • Dry eye due to being unable to blink or close the eyelid; conversely, a watery eye in response to dryness
  • Jaw or ear pain
  • Increase discomfort and sensitivity to sound in one ear
  • Loss of taste

Risk Factors for Bell’s Palsy

Bell’s palsy can occur in anyone of any gender and at any age, though can be found more commonly in the 15 to 45-year old age group. In the USA, it affects around 40,000 people annually.

Though the exact cause of Bell’s is not fully understood, it has been linked to some possible triggers. These include:

  • Pre-existing dormant viral infection, such as herpes simplex, mumps, and the flu
  • Your immune system being down from stress, illness, autoimmune disease, or fatigue
  • Infection of the facial nerve
  • Damage to the cells that insulate the nerve fibers

In addition to the above, some risk factors have been identified. A risk factor is one that can make you more likely to develop Bell’s palsy but does not mean you will definitely get it, nor does not having any risk factors mean you’re immune. Pregnant women tend to be more at risk of Bell’s, particularly in the third trimester or those with preeclampsia (pregnancy-related high blood pressure), as are those with diabetes, hypertension (high blood pressure), or obesity.

Bell’s Palsy Diagnosis and Management

There’s no one specific test for diagnosing Bell’s. Your doctor will perform a physical examination to assess facial muscle weakness and to rule out other causes of your symptoms. Relevant tests can include imaging, such as MRI or CT, blood tests, and electromyography, which is a test to measure the electrical activity of a muscle and its nerves.

An important note is that facial weakness or paralysis can also be a symptom of a stroke. Never assume your symptoms are simply due to Bell’s; any episode of muscle paralysis should be treated as an emergency until ruled out as otherwise by a doctor.
The majority of people with Bell’s palsy will make a full recovery even without intervention, though it may take several months. In the meantime, it’s a matter of managing your symptoms, such as providing special care for your eye to prevent it from developing complications from being unable to close.

If you’re able to see your doctor within the first few days of noticing symptoms, he or she may prescribe an oral steroid medication such as prednisone. This serves to reduce inflammation and swelling of the facial nerve, and starting steroids early has been linked to a greater likelihood of a full recovery. However, not everyone will be suitable for steroid treatment if they have certain other health conditions.

For bothersome pain behind your ear or around your jaw, you may consider taking painkillers such as aspirin or ibuprofen. However, always check with your treating doctor that these drugs won’t interact negatively with any of your other concurrent therapies.

Physical therapy can help to maintain your facial muscles while they recover as paralyzed muscles are known deteriorate from lack of use. You may be given certain exercises or taught how to massage your muscles. Infrequently, people with Bell’s may be recommended reconstructive surgery to correct long-lasting damage or dysfunction of certain parts of the face; for example, to help the eyelid close properly or lift the eyebrow so the face is more symmetrical.