Bell's palsy

Bell's palsy is a disorder characterized by sudden paralysis of the facial nerve. It may affect areas near the ear, tear glands, tongue and salivary glands, and various facial muscles. Typically, one side of the face is paralyzed. Rarely, both sides are affected.


Causes/associated factors
Researchers are still trying to understand what causes Bell's palsy, and they're coming closer to the answer. Many now believe the herpes virus is responsible for the condition, either alone or in combination with circulation problems or inflammation. Once the facial nerve is affected, it's thought to swell and be compressed by the bone through which it travels. This causes paralysis by blocking the impulses traveling down the nerve.
Bell's palsy affects both men and women in all age groups, but it's more common in the 50s and 60s. Pregnancy, diabetes, high blood pressure and recent respiratory infections all increase the risk of developing Bell's palsy.


Signs/symptoms
Bell's palsy usually develops suddenly, often overnight. In some cases, however, it may progress over a few days. Pain behind the ear is the most common early symptom. Other symptoms may include:
painful sensations in the face
hypersensitivity to sound on the affected side
taste disturbance
facial weakness, drooping, numbness or stiffness
difficulty closing one eye and making facial expressions
dry eyes or excess tearing
drooling
facial paralysis, which may lead to difficulty eating, drinking and speaking

Diagnosis
The doctor will review your medical history and do a physical and neurological exam.
First, other disorders that can cause similar symptoms -- such as infection, Lyme disease (a tick-borne illness), shingles, tumor or stroke -- will be ruled out.

You may need various tests, including hearing and balance tests. The doctor may do muscle testing to determine the degree of any nerve damage, as well as monitor the functioning of your facial nerve.

If your symptoms don't indicate a classic case of Bell's palsy, you may need magnetic resonance imaging (MRI, an imaging technique based on computer analysis of the body's response to a magnetic field) or computed tomography (CT scan, a computer-generated, cross-sectional picture of internal body parts).


Treatment
There's no known cure for Bell's palsy. Most people begin to notice improvement within two to three weeks. About 80 percent of people who have Bell's palsy recover completely within three months. The recovery period is sometimes much longer, however, and some people never enjoy a full recovery.
Poor recovery is most common for elderly adults, people who have sensitive hearing, and those who experience severe pain in the initial stages of the paralysis. About 10 percent of people who have Bell's palsy experience recurring attacks.

Conservative treatment
The doctor may recommend using moist, warm compresses and gently massaging the affected area of your face.

To decrease acute inflammation and pain, certain pain relievers and oral steroid medications, such as prednisone, may be prescribed for a short time.

Because Bell's palsy may be related to the herpes virus, some doctors also prescribe antiviral medications, such as acyclovir. Researchers are continuing to explore the benefits of this approach.

To protect your cornea if you have trouble closing the affected eyelid, the doctor may suggest a special eye ointment, artificial tears or protective glasses, patches or goggles.

Surgical treatment
If Bell's palsy causes permanent, complete facial nerve damage, surgery may be recommended to connect the end of the facial nerve with another nerve (the spinal accessory of the hypoglossal nerve). This may allow your eye to close when you're asleep and restore tone to the muscles of your face. The surgery is considered controversial because the results are often disappointing.


Complications
Possible complications of Bell's palsy may include:
facial disfigurement from paralysis
eye problems, such as corneal ulcers or infection
spasms or involuntary muscle movements of the face or eyelids
persistent problems with taste

Pregnancy-specific information
Pregnancy significantly increases the risk of Bell's palsy. Most pregnant women who develop this condition are in the third trimester. Fortunately, pregnancy doesn't affect the expected recovery from Bell's palsy and there's no known effect on the developing baby. Consult your doctor about the pros and cons of steroid treatment during pregnancy.

Senior-specific information
Growing older is a risk factor for Bell's palsy. Again, the condition is most common during the 50s and 60s. Also, age is a risk factor for a poor outcome. Be sure to consult your doctor promptly if you experience any signs of Bell's palsy.

Prevention
While researchers are studying the potential causes of Bell's palsy, there's no known way to prevent the condition.