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Bell's Palsy

Definition

Bell's palsy is a sudden weakness or paralysis on one side of the face. It is usually a temporary condition.

Bell's Palsy: Facial Droop

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Causes    TOP

The exact cause of Bell's palsy is unknown. It is thought to be a result of an infection or inflammation that affects the nerve.

Examples include:

Risk Factors    TOP

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

Symptoms    TOP

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 advanced 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 on one side
  • 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

Symptoms will often go away on their own within a few weeks. Bell's palsy may resolve after a few months in many people. In some cases, some symptoms of Bell's palsy may never go away. The recovery rate decreases with increasing age.

Diagnosis    TOP

Physicians will attempt to differentiate between between Bell’s palsy and other causes of facial weakness (including stroke and tumor). You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis is usually made with just the physical exam. Information from your health and medical history may be used to determine a potential cause.

Concern about infections, cancer, or other specific causes may require further testing. Tests may include:

Treatment    TOP

For Bell's palsy, treatment most frequently involves medications. You may be referred to a specialist if you have eye problems, if your symptoms worsen, or if your recovery takes longer than expected.

If the facial weakness is due to a cause other than Bell's palsy, treatment for underlying conditions may include medication or surgery.

Medication

Your doctor will likely prescribe corticosteroids if your symptoms have been present for a short time.

Antiviral medications along with corticosteroids may be advised. There is no evidence that antiviral medication alone has any benefit.

Self-care

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

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

Massaging the weakened facial muscles may also help.

Therapy    TOP

Physical therapy may be advised to improve function.

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

Prevention    TOP

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

RESOURCES:

Centers for Disease Control and Prevention
http://www.cdc.gov
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. Family Doctor—American Academy of Family Physicians website. Available at:
...(Click grey area to select URL)
Updated April 2014. Accessed October 2, 2017.
Bell's palsy. American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
...(Click grey area to select URL)
Accessed October 2, 2017.
Bell palsy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116940/Bell-palsy. Updated December 9, 2016. Accessed October 2, 2017.
Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngol. 2008;265(7):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(7):830-6.
NINDS Bell’s palsy information page. National Institute of Neurological Disorders and Stroke website. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Bells-Palsy-Information-Page. Accessed October 2, 2017.
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.
Schwartz SR, Jones SL, Getchius TS, Gronseth GS. Reconciling the clinical practice guidelines on Bell’s palsy from the AA-HNSF and the AAN. Neurology. 2014;82(21):1927-1929.
11/6/2007 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116940/Bell-palsy: 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(16):1598-1607.
1/6/2009 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116940/Bell-palsy: 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(11):993-1000.
9/15/2009 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116940/Bell-palsy: 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(6):558-564.
9/15/2009 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116940/Bell-palsy: 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(9):985-993.
2/13/2014 DynaMed's Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T116940/Bell-palsy: Baugh BF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013;149(3 Suppl):S1-S27.
Last reviewed September 2017 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 10/13/2016

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