Bell’s palsy is a weakness or paralysis of the facial muscles. It occurs when the seventh facial nerve is damaged, resulting in a droopy appearance to one side of the face. The majority of cases of Bell’s palsy are temporary, and the symptoms may resolve as early as 2 weeks. Some 40,000 Americans are affected by it each year; 80% recover within 3 months. The condition is most often connected with a viral infection such as herpes (the virus that causes cold sores), Epstein-Barr (the virus that causes mono) or influenza. It’s also associated with the infectious agent that causes Lyme disease. Of course, this doesn’t mean that everyone who has a viral infection or Lyme disease will develop Bell’s palsy – most people don’t. But in a few people, the immune system’s response to a viral infection leads to inflammation of the nerve. Because it’s swollen, the nerve gets compressed as it passes through a small hole at the base of the skull, which causes the symptoms of Bell’s palsy. Incidence of Bell’s palsy in males and females, as well as in various races, is approximately the same. The severity of the condition (e.g., mild or severe), and the rate of recovery also is equal. Bell’s palsy can affect people of all ages, but it is most common in adults. People with diabetes and pregnant women are more likely to develop Bell’s palsy.
The most common symptoms of Bell’s palsy are facial weakness or paralysis, a dry eye or mouth and problems tasting. The severity of symptoms depends on the extent of facial nerve damage and varies from mild weakness to complete paralysis. Bell’s palsy usually affects both the upper and lower parts on one side of the face. Both sides of the face are affected in less than 1% of cases. Symptoms usually come on suddenly; in about 60% of cases, patients are recovering from a recent upper respiratory infection or other viral infection. Several hours before the onset of facial weakness, many people experience pain behind the ear or in the back of the head. In addition to paralysis of the face, other symptoms include dizziness, drooling, dry mouth, facial twitching, hypersensitivity to sound, inability to blink or close the eye, tearing and dry eyes, impaired sense of taste and impaired speaking. A diagnosis of Bell’s palsy is often based on these symptoms and by ruling out other disorders. Other conditions that may cause facial paralysis include facial tumors, certain cancers and autoimmune diseases. The physician can usually exclude other disorders by taking the patient’s history of symptoms, and by examining the head, neck, ears and eyes.
There is no curative treatment for Bell’s palsy. Symptoms, especially in the eyes, are treated to prevent permanent damage. Treatment also attempts to reduce inflammation of the facial nerve. Daytime treatment of the eye is relatively simple. Artificial tears are instilled about every 2 hours to keep the eye moist and patients can manually close the affected eye to keep moisture in and debris out. Sunglasses can help protect the eye from injury and reduce dryness by decreasing exposure to wind. At night or during sleeping, a heavy lubricant is usually placed in the eye and the eyelid is taped shut to reduce dryness and the risk for injury. Corticosteroids, such as prednisone, are used to reduce swelling and inflammation of the facial nerve. Whether or not this treatment speeds up healing and improves the chances for complete recovery has not been determined. Once the decision has been made to use corticosteroids, they should be started within 2 days after symptoms develop. Treatment is continued for 1 to 2 weeks. It is also important to eat well and get lots of sleep when you have Bell’s palsy. Good nutrition and rest will help your body as it heals itself.
Although it can seem frightening at first, most people with Bell’s palsy recover fully within 1 to 3 months. A few people are left with some permanent facial weakness after recovering from the condition, though. One of the hardest things about having Bell’s palsy can be dealing with the emotions that go with it. To begin with, Bell’s palsy can be just plain scary. And because Bell’s palsy affects how your face looks for a while, you may feel self-conscious or embarrassed in public. Even your close friends may tease you in what they think is a good-natured way, but if it feels hurtful to you, tell them. Let people know why your face looks the way it does. Bell’s palsy isn’t contagious, so no one can catch it from you, and nothing you or anyone else did caused it to happen. Dealing with a condition like Bell’s palsy often helps you find out who your friends really are. Rely on the people you know can offer you the best support – your closest friends, family or a school counselor, for example. Within a couple of months, you should be back to your old self.