Bell’s Palsy Management

Bell’s palsy is a condition that causes sudden weakness or paralysis in the muscles on one side of the face.

It usually develops quickly within 3 days. This weakness causes half of your face to droop resulting in your smile becoming one-sided (lobsided). Your eye on the affected side will also resist closing. People who develop Bell’s palsy may think that they have had a stroke as it can cause similar symptoms. Bell’s palsy, however, is caused by the inflammation of a facial nerve and not by a stroke.

Having Bell’s palsy can be very distressing, causing anxiety and depression, especially in prolonged cases. Over 70% of people with Bell’s palsy, however, make a full recovery within 9 months. In rare cases, the facial weakness can be permanent.

The exact cause of Bell’s palsy is unknown, but it is suspected to be linked to herpes viral infections, a weakened immune system and stress. It is very important to see your GP as soon as possible after developing symptoms of Bell’s palsy as treatment is most effective if started within 72 hours (3 days).

What Are The Symptoms Of Bell’s Palsy?

It is important to see you doctor urgently if you suddenly develop weakness or paralysis on one side of your face. Symptoms of Bell’s palsy include:

• Partial or complete paralysis of one side of the face
• Eye irritation, such as dryness or more tears
• Inability to close the affected eye
• Sharp pain in the inner ear during the onset of paralysis
• Sensitivity to loud noise
• A drooping eyelid or corner of the mouth
• Drooling
• A dry mouth
• A loss of taste

What Causes Bell’s Palsy?

Bell’s palsy can affect anyone at any age although it is uncommon before age 15 or after age 60. The condition is most common in pregnant women, and people who have diabetes, influenza, a cold, or another upper respiratory ailment. Bell’s palsy affects men and woman equally.

The exact cause of Bell’s palsy is unknown although it is thought to be due to an immune response that triggers inflammation in the nerve controlling movement of the face. Possible triggers of Bell’s palsy may include a viral infection (such as Ramsay Hunt syndrome or herpes), impaired immunity from stress, sleep deprivation, physical trauma, high blood pressure, multiple sclerosis, Lyme disease or autoimmune syndromes.

How Is Bell’s Palsy Diagnosed?

There is no specific test for Bell’s palsy. Your doctor will make a diagnosis based on your physical symptoms and/or by ruling out other possible conditions such as stroke, infections, Lyme disease, inflammatory conditions, or tumours. If the cause of your symptoms remains unclear, your GP may recommend other tests, including:

• Electromyography (EMG): This test can confirm the presence of nerve damage and determine its severity.
• Imaging scans: Magnetic resonance imaging (MRI) or computerised tomography (CT) may occasionally be used to rule out other possible sources of facial nerve inflammation such as a tumour or skull fracture.
• Blood tests: Blood tests can be used to rule out Lyme disease and other infections.

Treating Bell’s Palsy

One of the main symptoms of Bell’s Palsy is the compression of the facial nerve. The best recovery occurs where the duration and severity of inflammation that causes the compression, is minimised.

The main treatment to help reduce inflammation in the facial nerve is a 10-day course of steroid medicine such as prednisone. If a viral infection such as Ramsay Hunt syndrome or herpes is suspected, antiviral drugs, such as acyclovir, may also be prescribed although their efficacy in treating Bell’s palsy is debatable. To be effective, steroids and antiviral medication need to be given within 72 hours of the symptoms appearing.

Eye care is extremely important in the early stages of Bell’s palsy. As you will most probably not be able to close your affected eye, it is important to protect the eye from becoming damaged. To keep your eye healthy and moist, your doctor will prescribe lubricating eye drops (for day) and eye ointment (for night). If needed, surgical tape can be used at night to keep your eye closed. It might also be useful to wear glasses during the day and an eye patch at night to protect your eye from getting damaged.

If you have Bell’s palsy, it is important not to do any forceful facial exercises to correct the paralysis. This is because exercises of this nature can encourage the development of synkinesis – a condition that causes the involuntary (unintentional) contraction of other muscles.

Rather, you should see a physical therapist who can teach you how to massage and exercise your paralysed facial muscles to help prevent them from shrinking or becoming shorter.

If your symptoms have not subsided after 3 weeks, you should consult your doctor.

Treating Prolonged Or Permanent Bell’s Palsy

Although most people make a full recovery within 9 months and recover full facial strength and expression, it can take longer. Rarely, the facial weakness can be permanent.

If you have not fully recovered within three months, it could be because the nerve damage was more extensive. In this case, your doctor may refer you to a specialist for additional treatment and/or investigations. Additional treatments may include:

• Referral to a physiotherapist or speech and language therapist for facial rehabilitation therapy.
• The specialist use of botulinum toxin (botox) injections to reduce overactivity in muscles and to restore a more balanced facial expression.
• If you still experience severe symptoms after 2 years some surgical procedures may be required. This option is normally only offered if you have already undergone a course of facial therapy.

Frequently Asked Questions