Bells Palsy

Bells Palsy is a sudden weakness and paralysis on one side of the face.

Causes

The cause of Bells Palsy is unknown. It is suspected that an irritated facial nerve becomes swollen due to inflammation. As the facial nerve passes through narrow openings in the skull, it is compressed and symptoms result. Doctors believe a herpes virus may cause the nerve to become inflamed. Head or facial injuries, tumors, other medical problems or exposure to cold may also cause Bells Palsy.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Family members who have Bell's palsy
  • Pregnancy
  • Diabetes mellitus
  • Cold or flu
  • Weakened immune system

Symptoms

Bells Palsy symptoms may come on suddenly or develop over a few days. Initial symptoms may include:
  • Pain behind the ear that precedes the weakness and paralysis
  • Ringing sound in the ears
  • Slight fever
  • Slight hearing impairment
Symptoms of full-blown Bell's palsy may include:
  • Facial weakness or paralysis
  • Usually one side
  • Forehead is smooth
  • Not able to smile
     
  • Numbness just before the weakness starts
  • Drooping corner of the mouth
  • Drooling
  • Tearing or decreased tearing
  • Inability to close an eye, which can lead to:
  • The eye becoming dehydrated
  • Ulcers forming on the cornea
  • Infection
  • Possible loss of the eye
     
  • Dry eye
  • Impaired taste
  • Sound sensitivity in one ear
  • Earache
  • Difficulty speaking

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam.

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

Tear Test – measures the eye's ability to produce tears

CT or MRI scan – to see if there is an infection, tumor, bone fracture, or other problem in the area of the facial nerve

Electrical Test – to see how badly the facial nerve is damaged

Blood tests – to check for diabetes, HIV infection, or Lyme disease

Treatment

In most cases, symptoms go away within a few weeks without treatment. Many cases of Bells Palsy completely resolve after a few months. For some patients, however, symptoms may never go away. No cure or standard treatment exists for Bells Palsy. Except for protecting the eye that does not close, treatment is considered controversial. If an underlying cause of the symptoms is known, it is treated.

Medication

  • Corticosteroids or nonsteroidal anti-inflammatory – to reduce inflammation and pain (The success of using these drugs has not been proven.)
  • Antibiotic or antiviral drugs – if infection is the cause

Surgery

Some doctors try to surgically relieve pressure on the nerve by removing part of the bone. This is an unproven procedure that is considered controversial. If the eyelid will not close, other surgeries may be considered.

Self Care

Patients may need to apply lubricant or put drops in the eye. The eye can be covered and taped closed at night. Do not place tape directly on the eyelid. An eye patch may be worn to keep the eye closed. This helps moisten and keep particles out of the eye.

Therapy

Most patients who do not recover are distressed by their symptoms. They may need help dealing with the emotional issues associated with the condition.

Prevention

There are no guidelines for preventing Bells Palsy because the cause is unknown and there are no tests to detect it before symptoms begin. If you think you are at risk for Bells Palsy talk to your doctor about ways to reduce your risk factors.