Bell's Palsy

Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to a facial nerve. Generally, the condition affects only one of the two facial nerves and one side of the face; however, in rare cases, it can affect both sides.

Bell's palsy is named for Sir Charles Bell, a nineteenth-century Scottish surgeon who was the first to describe the condition. Bell's palsy, which is not related to stroke, is the most common cause of facial paralysis.

Causes of Bell's Palsy

Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown.

Viral Infection as a Possible Cause of Bell's Palsy

Most research scientists believe that a viral infection such as viral meningitis or the common cold sore virus -- herpes simplex -- causes Bell's palsy. They believe that the facial nerve swells and becomes inflamed in reaction to the infection, causing pressure within the fallopian canal and leading to an infarction (the death of nerve cells due to insufficient blood and oxygen supply).

In some mild cases (where recovery is rapid), there is damage only to the myelin sheath of the nerve. The myelin sheath is the fatty covering, which acts as an insulator, on nerve fibers in the brain.

Other Possible Causes

There are several medical conditions associated with Bell's palsy. While scientists do not believe these conditions are specific Bell's palsy causes, people with these conditions may be at increased risk for developing the condition. Medical conditions associated with Bell's palsy include:

• Influenza or a flu-like illness
• Headaches
• Pregnancy
• Chronic middle ear infection (otitis media)
• High blood pressure (hypertension)
• Diabetes
• Sarcoidosis
• Tumors
• Lyme disease
• Trauma such as skull fracture or facial injury.

Who Is Affected by Bell's Palsy?

Bell's palsy afflicts approximately 40,000 Americans each year. It affects men and women equally, and can occur at any age, but it is less common before age 15 or after age 60.

Is Bell's Palsy Contagious?

Is Bell's palsy contagious? While doctors can seldom explain why one person gets Bell's palsy and another does not, it is clear that Bell's palsy is not contagious; no one can "catch" it from another person.

Common Bell's Palsy Symptoms

Common symptoms of Bell's palsy may include:

• Twitching, weakness, or paralysis on one or both sides of the face
• Drooping of the eyelid and corner of the mouth
• Drooling
• Dryness of the eye or mouth
• Impairment of taste
• Excessive tearing in one eye.

Most often, these symptoms, which can begin suddenly and reach their peak within 48 hours, lead to significant facial distortion.

Other Symptoms of Bell's Palsy

Other symptoms seen with Bell's palsy may include:

• Pain or discomfort around the jaw and behind the ear
• Ringing in one or both ears (tinnitus)
• Headache
• Loss of taste
• Hypersensitivity to sound on the affected side
• Impaired speech
• Dizziness
• Difficulty eating or drinking.

Bell's Palsy Symptoms: Final Thoughts

These possible symptoms are not sure signs of Bell's palsy. Other health problems can also cause these symptoms. Anyone with possible symptoms of Bell's palsy should see a healthcare provider. Only a qualified healthcare provider can properly diagnose and treat the problem.

Bell's Palsy Diagnosis

The first step in reaching a Bell's palsy diagnosis often involves the doctor asking the patient a number of questions. A doctor making a Bell's palsy diagnosis will then perform a physical exam and likely recommend certain tests. When diagnosing Bell's palsy using a physical exam, the doctor will examine the individual for upper and lower facial weakness. While there is no specific laboratory test to confirm a Bell's palsy diagnosis, the doctor may employ imaging tests such as electromyography (EMG), magnetic resonance imaging (MRI), and computed tomography (CT) scans.

Bell's Palsy Treatment

The most important factor in treating Bell's palsy is to eliminate the source of the nerve damage.

Bell's palsy affects each individual differently. Some cases are mild and do not require treatment, as the symptoms usually improve on their own within two weeks. For others, options may include medications and other therapeutic options. There is no cure for Bell's palsy.

Medications to Treat Bell's Palsy

Recent Bell's palsy research studies have shown that steroids are an effective treatment. Steroids are used to reduce inflammation and swelling. Studies also have shown that an antiviral drug, such asacyclovir, combined with an anti-inflammatory drug, such as the steroid prednisone, may be effective in improving facial function by limiting or reducing damage to the nerve.

Analgesics, such as aspirin, acetaminophen, or ibuprofen, may relieve pain. Because of possible drug interactions, people taking prescription medicines should always talk to their doctors before taking any over-the-counter drugs.

Eye Protection as a Bell's Palsy Treatment

Another important factor in Bell's palsy treatment is eye protection. The condition can interrupt the eyelid's natural blinking ability, leaving the eye exposed to irritation and drying. Therefore, keeping the eye moist and protecting it from debris and injury, especially at night, is important. Lubricating eyedrops (such as Artificial Tears^®, or eye ointments or gels), and eye patches are also effective treatments for Bell's palsy.

Physical Therapy for Treating Bell's Palsy

Physical therapy to stimulate the facial nerve and help maintain muscle tone may be beneficial to some people with Bell's palsy. Facial massage and exercises may help prevent permanent contractures (shrinkage or shortening) of the paralyzed muscles before recovery takes place. Moist heat applied to the affected side of the face may help reduce pain.

Alternative Bell's Palsy Treatment

Some alternative Bell's palsy treatments may be useful for certain individuals. Alternative treatments that have been used for this condition include:

• Relaxation techniques
• Acupuncture
• Electrical stimulation
• Biofeedback training
• Vitamin therapy (including vitamin B₁₂, B₆, and zinc), which may help nerve growth.

Before trying any type of alternative treatment, people should discuss its possible benefits and harmful effects with their doctor.

People may want to ask these questions about alternative options to treat Bell's palsy:

• What benefits can I expect from this approach?
• What are its risks?
• Do the expected benefits outweigh the risks?
• What side effects should I watch for?
• Will this alternative method change the way my current treatment for Bell's palsy works?
• Could this be harmful?
• Is this approach under study in a clinical trial? If so, who sponsors the trial?
• Will my health insurance pay for this approach?

Surgical Treatment for Bell's Palsy

In general, decompression Bell's palsy surgery, designed to relieve pressure on the nerve, is controversial and is seldom recommended. On rare occasions, cosmetic or reconstructive surgery may be needed to reduce deformities and correct damage, such as an eyelid that will not fully close or a crooked smile.

Bell's Palsy Recovery

For people, the complete recovery time from Bell's palsy ranges from three to six months. Typically, improvement is gradual, but recovery will vary from person to person.

Bell's Palsy During Pregnancy

For reasons not completely understood, women may develop Bell's palsy during pregnancy more frequently than the general population. The risk of Bell's palsy during pregnancy is thought to be greatest during the third trimester, or within several weeks of delivery. The prognosis for women with Bell's palsy during pregnancy is generally good. Bell's palsy does not appear to have any effect on the growing fetus.

Bell's Palsy Research

Bell's palsy research now under way is focused on learning more about the circumstances and conditions that cause nerve damage. Other Bell's palsy research is aimed at developing methods to repair damaged nerves and restore full use and strength to injured areas. Bell's palsy research already has led to many advances, and researchers continue to search for more effective treatment methods.