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Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention

Definition

Bell's palsy is a sudden weakness and paralysis on one side of the face. It is usually a temporary condition however, recovery rate decreases with increasing age.

Bell's Palsy: Facial Droop

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Causes

The exact cause of Bell's palsy is unknown. It occurs as a result of pressure on the nerve, or an infection or inflammation in the nerve.

Pressure may be caused by:

  • Tumors or cancers pressing on the nerve
  • Trauma from head or facial injuries

Nerve infections include:

Risk Factors

Factors that may increase your risk of Bell's palsy include:

Symptoms

Bell's palsy symptoms may come on suddenly or develop over a few days. Initial symptoms may include:

  • Pain behind the ear that is followed by weakness and paralysis of the face
  • Ringing sound in the ears
  • Slight hearing impairment
  • Slight increase in sensitivity to sound on the affected side.

Symptoms of full-blown Bell's palsy may include:

  • Facial weakness or paralysis, most often on one side
  • Numbness just before the weakness starts
  • Drooping corner of the mouth
  • Drooling
  • Decreased tearing
  • Inability to close an eye, which can lead to:
    • Dry, red eyes
    • Ulcers forming on the eye
    • Infection
  • Problems with taste
  • Sound sensitivity in one ear
  • Earache
  • Slurred speech

Late complications can occur 3-4 months after onset and can include:

  • Long-lasting tightening of the facial muscles
  • Tearing from eye while chewing

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

  • Blood tests
  • Hearing test
  • Lumbar puncture to test the fluid around the spine and brain
  • Electrical test (NCM/EMG)
  • Balance test
  • Tear test

Imaging tests, such as CT scan or MRI, allow for pictures of internal body structures.

Treatment

For most, treatment is not needed. Symptoms will often go away on their own within a few weeks. Bell's palsy may completely resolve after a few months in many people. For some people, some symptoms of Bell's palsy may never go away.

If an underlying cause of the Bell's palsy is known, it may be treated. Treatment will be based on that condition.

Your doctor may prescribe corticosteroids. This is a medication that can decrease swelling and pain.

Antiviral medications may also be recommended. This medication may help treat viruses associated with Bell's palsy. It will only be used if your doctor believes the palsy is caused by a virus. Antiviral medication is used in combination with corticosteroids.

Antibiotics for bacterial infections, such as Lyme disease.

If the paralysis includes your eyelid, you may need to protect your eye. This may include:

  • Lubricant or eye drops
  • Covering and taping eye closed at night
  • An eye patch to keep the eye closed

Massaging of the weakened facial muscles may also help.

Symptoms can be very distressing. Counseling can help you manage emotional issues and make appropriate adjustments.

Physical therapy and speech therapy may also help. Therapists may help reduce your symptoms or decrease their impact on your daily activities.

If you are diagnosed with Bell's palsy, follow your doctor's instructions .

Prevention

There are no current guidelines to prevent Bell's palsy.

RESOURCES:

Facial Paralysis & Bell's Palsy Foundation

http://www.facialparalysisfoundation.org

National Institute of Neurological Disorders and Stroke

http://www.ninds.nih.gov

CANADIAN RESOURCES:

Public Health Agency of Canada

http://www.phac-aspc.gc.ca

References:

Bell's palsy. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/bellsPalsy.cfm. Updated December 2010 . Accessed June 26, 2013.

Bell’s palsy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated April 22, 2013. Accessed June 26, 2013.

Bell’s palsy fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/bells/bells.htm. Updated September 4, 2012. Accessed June 26, 2013.

Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngology. 2008;265:743-752.

Grogan PM, Gronseth GS. Practice parameter: steroids, acyclovir, and surgery for Bell’s palsy (an evidence based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56:830-6.

Bell's palsy . American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/bells-palsy.html. Updated February 2011. Accessed June 26, 2013.

Quant EC, Jeste SS, Muni RH, et al. The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis. BMJ. 2009;339:b3354.

11/6/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Sullivan FM, Swan IR, Donnan PT, Morrison JM, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med. 2007;357:1598-1607.

1/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Engstrom M, Berg T, Stjernquist-Desatnik A, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol. 2008;7:993-1000.

9/15/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: Goudakos JK, Markou KD. Corticosteroids vs corticosteroids plus antiviral agents in the treatment of Bell palsy: a systematic review and meta-analysis. Arch Otolaryngol Head Neck Surg. 2009;135:558-564.

9/15/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what: de Almeida JR, Al Khabori M, Guyatt GH, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. 2009;302:985-993.

Last reviewed June 2013 by Rimas Lukas, MD; Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


 
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