What is Bell’s Palsy?
Bell’s palsy is a medical condition that causes temporary weakness or paralysis of the facial muscles. This medical condition is named after the Scottish anatomist named Charles Bell. He was the first one to describe the condition. Bell's palsy usually happens when the nerves, which control the facial muscles, become swollen, compressed, or inflamed.
In Bell's palsy, one side of the face tends to droop or becomes very stiff. This medical condition only affects one part of the face at a time. The individual who is suffering from this condition would find it difficult to even smile or close his eyes, especially on the affected side. In most scenarios, Bell’s palsy is a temporary form of paralysis and its symptoms go away within a few weeks’ time. It has been said that the cause of Bell’s palsy could be due to some kind of trauma or impact to the seventh cranial nerve, which is also called as the facial nerve.
There is no known age when this condition can occur. It can occur at any age and to any individual regardless of gender or race. However, studies have shown that Bell’s palsy is commonly seen in individuals in the age bracket of 16 to 60 years old. It has also been noticed that people who have diabetes or are recovering from any type of viral illness are also at an increased risk of developing this condition.
Most people often confuse Bell’s palsy with stroke since they have similar symptoms. However, these two medical conditions are different. Stroke is usually caused by a clot, which hinders the flow of blood to the brain. It can also be caused by a ruptured blood vessel in the brain. Bell’s palsy, on the other hand, is mainly due to facial nerve damage.
The symptoms of Bell's palsy usually start to develop around one to two weeks after the individual has a cold, eye or ear infection. The symptoms just appear all of a sudden. One may not notice it initially after waking up in the morning or while they are eating or drinking.
The most common sign of Bell's palsy is a droopy appearance on one side of the face. Affected individuals would find it difficult to even open their eyes. Although quite rare, Bell's palsy can also affect both sides of the face.
Below are some of the signs and symptoms associated with Bell’s palsy:
- Facial weakness
- Constant drooling
- Increased sensitivity to sound
- Difficulty in eating or drinking
- Twitching of facial muscles
- Dry mouth or eyes
- Headaches that tend to become severe
- Unable to make any kind of facial expressions such as frowning or smiling
- A difficulty in closing the eyelid or even blink
- Finding it difficult to chew, especially on the affected area
- Pain or numbness behind the ear
- The eyes tend to water more or less than usual
The symptoms of drooping or facial weakness tend to reach their peak within a day or two. In such a scenario, seek medical attention or consult a doctor immediately. Do not try to self-diagnose Bell’s palsy since at times, the symptoms of this condition can also be similar to other forms of serious conditions such as brain tumor or stroke. In most cases, people tend to recover after a couple of weeks. It has been reported that most people completely recover within a period of three months. However, in rarest cases, the symptoms tend to worsen or become severe, thereby taking a long time to recover.
Bell's palsy is known to occur when the seventh cranial nerve becomes inflamed, swollen, or compressed. This cranial nerve passes through a narrow and bony area within the skull. When this nerve slightly swells, it tends to push against the hard surface of the skull and affects the function of the nerves. This then results in a temporary facial weakness or paralysis.
Studies are unable to find the exact cause of Bell's palsy, but it is believed that certain types of viral infections can trigger the condition. Below is the list of viruses that have been linked to the development of Bell’s palsy:
- HIV virus - is known to cause damage to the health of the immune system.
- Epstein-Barr virus - is known to cause mononucleosis.
- Sarcoidosis - known to cause inflammation in the organs.
Who is at risk?
Individuals who fall in the following categories are at a higher risk of developing Bell's palsy:
- Individuals with diabetes
- Those who have a family history of Bell's palsy
- Patients suffering from lung infections
Currently, there is no specific test to confirm the diagnosis of Bell's palsy. Doctors mostly find out through “diagnosis of exclusion”. This is not tested as such. It means that the doctor would determine whether an individual has Bell’s palsy only once they rule out on all the other possible conditions. The doctor would first and foremost perform a careful physical examination. The doctor would ask patients to close their eyelids on the affected side of the face if the doctor suspects Bell’s palsy.
If the eyelid does not close, it is a medical sign that the patient has the "Bell's phenomenon". In this scenario, the individual would be able to roll his eyes upward and outwards in the process of closing them. The doctor would try to rule out the possibility of other medical conditions by carrying out other physical tests.
The doctor may also test the hearing and sense of balance of the individual. Additional tests such as a computed tomography or CT scan, X-ray of the skull, magnetic resonance imaging or MRI may be required. These tests can help confirm the diagnosis and in ruling out other possibilities. Moreover, the doctor is able to predict how fast the recovery can take place.
A test called electromyography or EMG can confirm the presence of nerve damage and also determine the extent of the damage done. In a few instances, blood tests can be carried out. It helps in the diagnosis of other coexisting medical conditions such as certain types of infections or diabetes.
In most cases, the symptoms of Bell’s Palsy improve on their own within a few weeks without the need of any treatment. But one should note that it can take several weeks or even months for the facial muscles to regain their normal strength back again. Below are some of the treatments that can help in the recovery process:
- Certain antiviral drugs can be prescribed if the condition is caused by a virus.
- Over-the-counter medications such as acetaminophen or ibuprofen for mild pain relief.
- Corticosteroid drugs help reduce inflammation in the nerves and shorten the duration of Bell's palsy symptoms.
- Gently massaging the affected side of the face.
- Placing a warm or moist towel over the face to relieve pain.
- Performing certain physical therapy exercises to stimulate the facial muscles rather than keeping them stiff. However, such exercises must be done under the guidance and supervision of a doctor to avoid any injury or worsening of the symptoms.
- Wearing an eye patch on the affected area since it would be difficult to blink. If the eyes are tearing more or less than normal, then eye drops can be applied to avoid them from getting dry.
- In rarest cases, the doctor can suggest for surgery to reduce the amount of pressure being put on the facial nerves. Surgery can be done only if the symptoms do not improve after some time.
Physical Exercises for Bell’s Palsy
There is no evidence or studies to support a significant amount of benefit or harm from conducting any kind of physical therapy for facial muscles. However, there have been customized facial exercises that intend to help and improve the functioning of the facial muscles.
Remember that Bell's palsy cases can vary from person-to-person. In certain individuals, the muscles would take a longer time to develop or have a hard time to develop movements. For these reasons, the movements should be corrected and well-coordinated with the help of retraining. The muscles that have been holding other muscles captive need to be retrained to allow other primary muscles to work or move properly.
The basic idea of performing these exercises is to slowly recreate the lost brain-to-nerve-to-muscle routine back again. The most important goal of the exercises is to ensure that one does the correct form of voluntary movements and at the same time, mentally focusing on the actions. Over a period of time, these voluntary movements would gradually become automatic and the natural form of movements, as well as the expressions, would be normal as well as automatic without the need to doing it on purpose. Such exercises are slow, but they surely give some amazing benefits.
Risks or Complications
Individuals who have previously encountered a similar episode of Bell’s palsy would completely recover without any complications. However, complications can occur in severe Bell’s palsy cases such as:
- Damage to the seventh cranial nerve, which is the nerve that controls the facial muscles.
- An excessive case of eye dryness that leads to certain eye infections, blindness, or ulcers.
- Synkinesis, which is an involuntary facial movement caused by an incomplete nerve damage recovery.
The prognosis for Bell's palsy patients is very good in general. Recovery from Bell's palsy is completely based on the severity or the extent of nerve damage. Although the improvement would be gradual or slow, it would surely happen. Moreover, the recovery time would vary from person-to-person. With or without treatment, improvements are usually seen within two weeks after the onset of symptoms.
Most of the patients have shown a gradual but complete recovery. They return back to carrying out their normal function just within three to six months after the onset of symptoms. In very rare cases, the symptoms can last longer than usual and in a few cases, the symptoms tend to stay forever. A few individuals can face the recurrence of Bell's palsy, which can happen on the same side or opposite side of the face.