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Bell's Palsy

Definition

Bell's palsy is a sudden weakness and paralysis on one side of the face. It is a temporary condition. Bell's palsy can occur in anyone but is most common in people with diabetes or those with a recent cold or flu infection.
Bell's Palsy: Facial Droop
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Causes

Bell's palsy is caused by damage to a nerve of the face. The exact cause of this damage is unknown. The damage to the nerve causes swelling along the nerve. The swelling puts extra pressure on the nerve. This extra pressure leads to paralysis of a part of the face.
Some infections are believed to cause some Bell's palsy. Herpes virus, flu virus, and Lyme disease may be associated with Bell's palsy.
Facial paralysis may also be caused by:
  • Head or facial injuries
  • Tumors
  • Diabetes
  • Cancer or infection in the cerebrospinal fluid (CSF)
  • Strokes
  • Abscess
  • HIV infection
  • Infection
  • Autoimmune disease
  • Drug therapy, such as chemotherapy
  • Hereditary diseases
  • Other conditions that cause paralysis of the facial nerve

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 fever
  • 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 (look for smooth forehead and problems smiling)—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.
Other tests may include:
  • Hearing test—to see if nerve damage involves the hearing nerve, inner ear, or hearing mechanism
  • Balance test—to see if balance nerves are involved
  • Lumbar puncture—a test of the cerebrospinal fluid (CSF) from the lower back; to rule out meningitis, autoimmune disorders, or cancer spreading from a tumor
  • Tear test—measures the eye's ability to produce tears
  • computed tomography (CT) scan—a type of x-ray that uses a computer to make pictures of structures inside the head to see if there is an infection, tumor, bone fracture, or other problem in the area of the facial nerve
  • Magnetic resonance imaging (MRI) scan—a test that uses magnetic waves to make pictures of structures inside the head to see if there is an infection, tumor, bone fracture, or other problem in the area of the facial nerve
  • Electrical test (NCM/EMG)—to evaluate for damage to the facial nerve
  • Blood tests—to check for diabetes, HIV infection, or Lyme disease

Treatment

For most, treatment is not needed. Symptoms will often go away on their own within a few weeks. Bell's palsy will 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.
Some treatments that may be used for Bell's palsy include:

Medication

Your doctor may prescribe corticosteroids. This is a medication that can decrease swelling and pain.
Antiviral medications may also be recommended. This medication will help weaken viruses associated with Bell's palsy. It will only be used if your doctor believes that palsy is caused by a virus.

Self-care

If the paralysis includes your eyelid, you may need to protect your eye. This may include:
  • Appling lubricant or putting drops in the eye.
  • Covering and taping eye closed at night.
  • Wearing an eye patch to keep the eye closed. This helps moisten and keep particles out of the eye.
Massaging of the weakened facial muscles may also help.

Therapy

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 guidelines for preventing Bell's palsy. If you think you are at risk for Bell's palsy, talk to your doctor. There may be steps you can take to reduce your risk.

RESOURCES

Bell's Palsy Information Site http://www.bellspalsy.ws/

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/

CANADIAN RESOURCES

Alberta Health and Wellness http://www.health.gov.ab.ca/

Health Canada http://www.hc-sc.gc.ca/

References

American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/HealthInformation/bellsPalsy.cfm. Accessed September 20, 2012.

Bell’s palsy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated July 25, 2012. Accessed September 20, 2012.

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 September 20, 2012.

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.

Kasper DL, Braunwald E, Fauci AS, et al. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: The McGraw-Hill Companies; 2005.

Bell's palsy . American Family Physician website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/bells-palsy.html . Updated February 2011. Accessed September 20, 2012.

Primary Care Medicine. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

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.

Rakel RE, Bope ET. Conn's Current Therapy. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Russell J. Bells palsy. In: Gilman S, ed. MedLink Neurology. San Diego, CA: MedLink Corporation.

Samuels MA, Feske SK. Office Practice of Neurology. Philadelphia, PA: Churchill Livingstone; 2003.

11/6/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: 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/: 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/: 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/: 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.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 10/2012 -
  • Update Date: 10/11/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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