Who Is At Risk

Bells palsy affects about 40,000 people in the United States every year. It can affect anyone of any gender and age, but its incidence seems to be highest in those in the 15- to 45-year-old age group. Risk factors for Bells palsy include pregnancy, preeclampsia, obesity, hypertension, diabetes, and upper respiratory ailments.

How Is Bell’s Palsy Treated

If a specific cause for Bells palsy is identified, such as infection, that cause will be treated. Otherwise, the symptoms are treated as needed.

One uniformly recommended treatment for Bell’s palsy is protecting the eye from drying at night or while working at a computer. Eye care may include eye drops during the day, ointment at bedtime, or a moisture chamber at night. This helps protect the cornea from being scratched, which is crucial to the management of Bell’s palsy.

Your healthcare provider will prescribe other treatment for your condition based on the severity of your symptoms and your health history. Other treatment options include:

• Steroids to reduce inflammation
• Antiviral medicine, such as acyclovir
• Analgesics or moist heat to relieve pain
• Physical therapy to stimulate the facial nerve

Some people may choose to use alternative therapies in the treatment of Bell’s palsy, but there is no proof they make a difference in recovery. Such treatment may include:

• Relaxation
• Vitamin therapy, including B12, B6, and the mineral zinc

Diagnosis Of Bell Palsy

• A doctor’s evaluation

• Sometimes various tests, depending on the suspected cause

Facial nerve palsy can usually be diagnosed and distinguished from other disorders based on symptoms. For example, facial nerve palsy can be distinguished from a stroke because a stroke usually causes weakness only in the lower part of one side of the face rather than in the entire side of the face. People who have had a stroke can close the eyes tightly and wrinkle the brow. Also, a stroke typically causes weakness of an arm and/or a leg.

Doctors can usually distinguish Bell palsy from other, less common disorders that cause facial nerve palsy . These other disorders typically cause different symptoms, and in many of them, symptoms develop more slowly. Thus, if doctors are not certain that Bell palsy is the cause or if symptoms developed gradually, tests are done. These tests include

• Blood tests

• X-rays

• Magnetic resonance imaging or computed tomography of the brain

For example, blood tests may be done to check for other causes of facial nerve palsy such as Lyme disease and a blood test and chest x-ray may be done to check for sarcoidosis. Usually, doctors can exclude other causes based on the persons symptoms and results of these tests.

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Bells Palsy And Ramsay Hunt Syndrome

The incidence of Bells palsy is generally about 20-22 per 100,000 population per year. The rate is highest in pregnant women, a bit over 40 per 100,000 pregnant women per year. The lowest incidence is in children and the best prognosis is in children. About 70% of folks who get Bells palsy develop a rapid onset, single sided facial paralysis. About 30% develop diffuse facial weakness on a single side which usually recovers completely within 1-3 weeks. Rarely, does acute viral facial paralysis develop on both sides simultaneously. For a bit over 70%, recovery is back to normal within a month. About half of those who take longer than a month to recover return to completely normal ,and about half have at least some permanent side effects, but, generally, less than 5% have readily noticeable long term facial weakness with other signs of dysfunctional movement. The poorest prognosis applies to the elderly and long term diabetics but all experience at least some recovery of function, almost always quite functional. The repeat facial palsy rate, same or opposite side, is about 6-7% and about 7-10% have a family history of a similar problem. If a repeat Bells palsy occurs, the odds of a third recurrence nearly doubles to about 12-15% and if a third palsy occurs, the odds of a fourth palsy exceeds a 20% risk.

You Cannot Prevent Bell’s Palsy

Because it’s probably caused by an infection, Bell’s palsy cannot usually be prevented. It may be linked to the herpes virus.

You’ll usually only get Bell’s palsy once, but it can sometimes come back. This is more likely if you have a family history of the condition.

Page last reviewed: 11 September 2020 Next review due: 11 September 2023

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How Bell’s Palsy Can Affect Your Eyes

Bells palsy is an acute paralysis of the facial nerve that controls the muscles of the forehead, eyelid, face, and neck.

People who experience Bells palsy often head to the emergency room because they think they’re having a stroke. The condition normally affects only one side of the face. People who suffer from Bells palsy may complain of a facial droop and pain or discomfort, and often notice symptoms in their eyes.

What Is The Prognosis Of Bells Palsy

The length of time it takes for the pressure on the nerve to be released and for it to recover is dependent on the initial damage.

• A large review showed that just over 70 per cent of people with Bells palsy make a full recovery. Improvement can occur as early as two to three weeks from onset however, a full recovery can take anywhere from three to six months and beyond.
• In the remaining 20-30 per cent of cases, the nerve damage is more severe and these individuals are left with ongoing symptoms, i.e. the muscles may not remain paralysed, difficulties may be due to synkinesis. Severe nerve damage is more likely to occur if the patient
• Is over 60

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What Is The Initial Treatment For Bells Palsy

The best recovery occurs where the duration and severity of nerve compression is minimised. The main treatment to help reduce inflammation and therefore relieve pressure on the facial nerve is oral steroids. If Ramsay Hunt syndrome is suspected antiviral drugs should be prescribed in addition.

Steroids and antiviral medication need to be given within 72 hours of the symptoms appearing in order to have any beneficial effects.

• Prednisolone is the steroid usually prescribed for the treatment of Bells palsy and has been shown to reduce the severity of an attack. Please note that after 72 hours there is no evidence that steroids are effective in improving recovery.
• Aciclovir is the antiviral drug which is often prescribed for the initial treatment of facial nerve palsy where it is suspected that Ramsay Hunt syndrome is responsible, for example, due to the presence of a rash or blisters in or around the ear, scalp or hair line. The blisters may also appear inside the mouth. Recent studies show that antivirals do not improve the outcome for patients with Bells palsy.

Please also note that in spite of prompt treatment with steroids, some patients will not recover fully but it is not fully understood why this is the case. Find out more about steroids and antivirals.

The video below has tips how to manage your facial palsy while your face is floppy. Please note this is a series of 7 short videos in one.

What Is It Called

The sudden onset of complete/partial paralysis of one side of the face is called BELLS PALSY.

When no definite proven cause could be related to this sudden development of facial nerve paralysis it is known as BELLS PALSY.

The facial nerve is the nerve that supplies all the muscles of the face. The involvement of this nerve causes one-sided paralysis of the face.

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Is There Is A Cure Or Remission Period

Most patients will be cured once the facial palsy resolves. However, in up to 12% of patients, recurrence may be noted, with multiple recurrences affecting about 3% of patients.

For more information about facial syndromes, contact Dr. Amit Kochhar, Director of the Facial Nerve Disorders Program at the Pacific Eye,Ear & Skull Base Center. or schedule an appointment online.

Image credit: allaboutvision.com

Bells Palsy Treatment And Recovery

This content was published in 2012. We do not recommend that you take any clinical decisions based on this information without first ensuring you have checked the latest guidance.

Palsy means paralysis. Bells palsy is a condition in which the inner ear becomes inflamed, resulting in pressure on, and even damage to, the facial nerve and causing facial paralysis.

The condition often presents suddenly, without warning, and can develop over a number of hours, peaking at 72 hours. The paralysis is usually restricted to one side of the face and may be partial or complete. Sometimes this is accompanied by a drooping of the affected side of the face, depending on the severity of nerve damage. Cognitive functioning and other physical abilities are not impaired. Other main symptoms include:

• Pain in the inner ear during the onset of paralysis
• Impaired or altered sense of taste
• Sensitivity to loud noise
• A dry eye
• Difficulty eating food may get trapped in some areas and there may be involuntary drooling
• Difficulty speaking clearly, particularly with pronouncing letters such as B and P

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Facial Nerve Palsy Symptoms

Facial nerve palsy affects one side of the face. It can affect the whole side or just part of a side of the face. The main symptom is weakness, but sometimes sensory changes, like tingling or loss of sensation, can also occur.

Symptoms of facial nerve palsy include:

• Droopy eyelid

• Choking on food, drinks, or saliva
• Trouble breathing

These complications can be serious, but they can often be prevented with measures such as wearing an eye patch to protect the eye.

What Types Of Symptoms Are Associated With Bells Palsy

Bells palsy patients will experience their entire face weaken or become completely paralyzed.

This includes inability to blink or close the eye, smile symmetrically, or chew food. This is in contrast to stroke victims, where only the lower part of the face will be weak, with preservation of eye function.

In addition, patients may complain of :

• Ringing in the ears
• Hearing sounds louder on the affected side

It is very important to note that Bells palsy is a diagnosis of exclusion. This means that other causes of facial weakness such as stroke, brain tumor, Guillan-Barre syndrome, ALS, trauma, post-surgical, infection, etc., should be ruled out.

Hence, a thorough evaluation of the entire body, as well as laboratory work-up and neuroimaging , is necessary before concluding one has Bells palsy.

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What Is The Treatment

Treatment will depend on the cause so you should see your GP. Your GP will take a history and decide whether you require a referral to a specialist dentist or doctor. You may be prescribed specific painkillers specially designed to treat nerve pain.

Studies show that botulinum toxin injections can help with residual facial pain, spasms and involuntary facial movements caused by facial palsy.

Bells Palsy Vs Stroke

Bells palsy should be treated right away, but it isntnecessarily an emergency.

A stroke, on the other hand, is a medical emergency. If you or someone you know experience facial droop along with any other symptoms of stroke, such as numbness, weakness, slurred speech, double vision or dizziness, or if the symptoms arent clear-cut, call 911. Its better to be safe than sorry.

Dr. Mays says there are a few additional signs that can helpdistinguish one from the other:

• A stroke comes on suddenly, whereas Bells palsyusually develops over the course of hours or days.
• Generally, its the lower part of the face thatbecomes weak when someone is having a stroke. With Bells palsy, both the lowerand upper part of the face will be affected, so it may be hard to blink or movethe eyebrows.

Other symptoms that someone with Bells palsy mightexperience include:

• Headache or pain behind the ear
• Loss of taste on one side of the tongue
• Sensitivity to sound in one ear
• Excessive tears in one eye

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Mechanism Of The Palsy:

The mechanism by which the face becomes paralyzed in Bells Palsy involves several factors. First, the causative virus must exist within the nerve that makes the face to smile, the facial nerve. For the virus to get to the nerve, the person likely will have contracted the virus from another person by sharing forks or other food implements or by other intimate contact with a person who was actively shedding virus. It is not generally contagious by simply being in the same room. From initial contact, the virus multiplies and causes at least a localized skin or mucous membrane infection. In some folks, the virus may spread via the blood stream or through nerves to infect nerves at distant parts of the body. From that initial infection, the body develops immunity which generally keeps the virus under control or dormant but the immune system is generally not capable of ridding all of the nerve cells of dormant virus. Recent research suggests that immunologic mechanisms exist which do suppress the virus living within the nerve cells. Later, something happens which appears to ratchet back these immunologic control systems, allowing the dormant virus to replicate and make the nerve sick.

Treatment Of Ramsay Hunt:

For those with Ramsay Hunt syndrome, , our preference is early, very high dose antiviral medication and high dose steroids, continuing both until at least the 21st day after disorder onset. While the published literature suggests that middle fossa facial nerve decompression is effective for Bells palsy, the question of adequacy of benefit from surgery has not been proven in Ramsay Hunt syndrome. Nevertheless, since nerve swelling seems to be the in-common issue that causes poor quality recovery, many think surgery is indicated for severe Ramsay Hunt facial paralysis.

In summary, Bells palsy can be a quite disfiguring disorder, but fortunately, for the vast majority, high quality recovery occurs within weeks. For those with delayed recovery, satisfactory function is highly likely but some degree of impairment, generally not severe, may remain. For those whose prognosis for a poor quality recovery seems high, surgery is a possibility. When facial paralysis features do not fit well with the classic features of Bells palsy or Ramsay Hunt syndrome, a careful evaluation for other causes is essential, as other very serious issues may exist for which other specific management is appropriate.

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What Are The Side Effects Of Bells Palsy And/or Its Treatment

The majority of patients receiving steroids will have short-term side effects (most of which resolve once the medication is halted, including insomnia, weight gain, gastritis and mood changes.

In diabetic patients, steroids can worsen blood sugar control and may require higher doses of insulin and other medications. Long-term , steroids can result in immunosuppression, easy bruising, wound breakdown, bony fractures or necrosis, cognitive changes, diabetes and high blood pressure.

Though the majority of patients will recover well, up to 30% of patients may develop permanent partial facial weakness, dry eyes and diminished taste.

It is imperative during the duration of severe facial weakness that the affected eye is protected . Corneal abrasions can occur if the eye is not kept safe, and blindness may result. Hence, the eye should be covered at night with an eyepatch or a piece of tape. During the day, the eye can be left uncovered, but artificial tears should be used copiously to prevent scleritis.

What To Do About Bell’s Palsy

Recovery takes time, patience, proper eye care, and maybe a medication.

Bell’s palsy is a sudden paralysis involving the nerve that controls the muscles on one side of the face. It can cause startling changes on the affected side: a drooping mouth, a sagging eyebrow and lower eyelid, and an eye that won’t fully close. Bell’s palsy is not life-threatening, and its symptoms are usually temporary, but they can be very distressing, interfering not only with facial appearance but also with the ability to speak, eat, sleep, or enjoy food. Recovery can take weeks to months, during which many people curtail their usual activities some become socially isolated.

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What Are The Risk Factors For Contracting Bells Palsy

This condition can affect both genders equally, though pregnancy does increase the risk 3-fold. Patients with diabetes, hypothyroidism and the elderly are at higher risk as well. Often, a viral infection precedes Bells palsy by 1-2 weeks. It is thought that such an illness can trigger Herpes virus to activate and cause painless facial weakness.

Key Points About Bell’s Palsy

• Bell’s palsy is an unexplained episode of facial muscle weakness or paralysis that usually resolves on its own and causes no complications.
• The cause of Bells palsy is unknown but is thought to be caused by inflammation affecting the bodys immune system. It is associated with other conditions such as diabetes.
• Symptoms of facial weakness or paralysis get worse over the first few days and start to improve in about 2 weeks.
• It can take 3 to 6 months to fully resolve.
• Medicine and eye care are important in treating Bells palsy.

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Healing From Bells Palsy

Below are some steps you can take not only to recover from Bells palsy, but also to prevent it from happening in the first place. Sometimes if you have Bells palsy once, it may come again because the virus in still active in a persons system. Its helpful to take these steps even if you arent experiencing Bells Palsy right now for this reason.

In addition, the shingles virus that causes Bells Palsy can cause many other symptoms and conditions if the virus is left unaddressed so if you are a loved one have had Bells Palsy or any of the symptoms and conditions listed below, it would be helpful to make the adjustments to your diet and supplements that I share in this article. Other symptoms shingles can cause include different kinds of rashes, neurological symptoms like twitching, tingling, burning, spasms, chronic migraines, and headaches, frozen shoulder, diabetic nerve pain, colitis, vaginal burning, TMJ, joint pain, muscle pain, neck pain, sciatic pain, sharp nerve pain, burning nerve pain, heart palpitations, and more. Medical communities are completely unaware that these symptoms are a result of one or more of the many varieties of the shingles virus.

To heal from shingles, there are certain foods that need to be avoided along with certain foods and supplements that help to inhibit and destroy the virus. Lets look at some of these now.