Bell's Palsy
Bell's palsy is an unexplained weakness or paralysis of the muscles on one side of the face that affects approximately 40,000-65,000 Americans each year. People with Bell's palsy may be unable to close the eye on the affected side, and may also experience tearing, drooling, and hypersensitive hearing. Bell's palsy can begin quite suddenly, sometimes appearing overnight. Although this disorder is unsettling and inconvenient, it is typically not indicative of a serious health problem. The weakness and paralysis eventually disappear in the majority of cases.
Facial palsies have been linked to conditions such as Lyme disease, ear infection, meningitis, syphilis, German measles (rubella), mumps, chickenpox, and infection with Epstein-Barr virus (e.g., infectious mononucleosis). Bell's palsy is diagnosed when these other conditions have been eliminated.
The root cause of Bell's palsy has not been identified. Although Bell's palsy is not life-threatening, it can present symptoms similar to truly serious conditions, such as a stroke, ruptured aneurysm, or tumors.
Although not considered a serious condition from a health standpoint, Bell's palsy can cause stress, embarrassment, and inconvenience for those affected. In the 80-85% of cases, the facial weakness or paralysis is temporary. However, individuals who experience complete paralysis seem to have a poorer recovery rate, with only 60% returning to normal.
The symptoms of Bell's palsy are the result of an inflammation or swelling of the facial nerve that controls the muscles on either side of the face. Swelling increases compression of the nerve. The nerve signal conduction is disrupted, leading the loss of muscle control.
Why the facial nerve becomes inflamed in Bell's palsy is not clear, but it may be related to an infection of the herpes simplex virus (HSV), the virus responsible for cold sores and fever blisters.
Although Bell's palsy is not life-threatening, it shares symptoms with serious conditions, such as stroke. Emergency medical attention is a wise precaution, and extensive testing may be needed to rule out the possibility that the patient is experiencing a more serious condition. Once all other possibilities are exhausted, a diagnosis of Bell's palsy is made. If facial movement, even a small amount, has not returned within 3-4 months, the diagnosis of Bell's palsy may need to be reevaluated.
Many doctors prescribe an antiviral or a steroid drug for Bell's palsy, but there is some controversy about whether these drugs actually help. If drugs are used, they need to be taken as soon as possible following the onset of symptoms. Antiviral drugs, such as acyclovir, famciclovir, or valacyclovir destroy actively replicating viruses and prevent further damage to the facial nerve. Steroids such as prednisone reducing swelling and compression of the nerve.
In the past, surgery was performed to relieve the compression on the nerve. However, this treatment option is now used very infrequently because it does not guarantee recovery, and it carries the risk of permanent nerve damage.
The need to protect the affected eye is important. Since the patient may not be able to lower the affected eyelid, the eye may become dry, particularly at night. Excessive dryness can damage the cornea. Daytime treatment includes artificial tears, an eye patch, or other protective measures. Nighttime treatment involves a more intense effort at keeping the eye protected. Eye lubricants or viscous ointments, along with taping the eye shut, are frequently recommended.
In cases of permanent nerve damage, cosmetic treatment options, such as surgery, may be suggested. Practitioners of traditional Chinese medicine have historically used acupuncture to treat Bell's palsy.
Most individuals with Bell's palsy begin to notice improvement in their condition within 2-3 weeks of the onset of symptoms. At least 80% of them will be fully recovered within three months. Individuals suffering permanent nerve damage may not regain control of the muscles on the affected side of the face. These muscles may remain weak or paralyzed. If the nerve recovers imperfectly, they may experience involuntary facial twitches or spasms that accompany normal facial expressions.
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