Bell'S Palsy

Bell's palsy, also called facial palsy or idiopathic facial paralysis (IFP) is the most common cause of sudden, unilateral paralysis of your facial muscles, which makes half of your face appear to droop.

This form of temporary paralysis occurs due to damage or trauma to the facial nerve, also called the 7th cranial nerve.

In this condition, the functions of the facial nerve get disrupted resulting in interrupted messages between the brain and the facial muscles.

This causes facial weakness or paralysis. Usually, Bell's palsy affects one of the paired facial nerves and hence only one side of your face, but in some cases, it may affect both sides.

Your smile becomes one-sided, and your eyelid on that side does not close properly. It can occur at any age, and in most cases may resolve on its own, but its exact cause is unknown.

It may be a reaction that occurs following a viral infection. The symptoms usually begin improving within a few weeks, and complete recovery takes around six months.

In some cases, symptoms of Bell's palsy continue for life.

Signs and symptoms of Bell's palsy vary in each person and appear all of a sudden. These includes:

• Rapid development of mild weakness to total paralysis affecting only one side of your face - occurring within hours to days
• Drooping of your eyelids and corner of the mouth
• Difficulty in making facial expressions, such as closing your eyes or smiling
• Drooling
• Dryness in the eye or mouth
• Impaired taste
• Pain or discomfort in the jaw or in or behind your ear on the affected side
• Ringing sensation in one or both the ears
• Increased sensitivity to sound on the affected side
• Headache
• Disturbances in speech
• Changes in a number of tears and saliva you produce
• Difficulty in eating or drinking

In rare cases, Bell's palsy can affect the nerves on both sides of your face.

When to see a Doctor Seek immediate medical attention if you experience any type of paralysis because you may be having a stroke. Bell's palsy is not related to stroke.

Consult your doctor if you experience facial muscle weakness or drooping so that the underlying causes and severity of the disease can be determined.

Although the exact cause of Bell's palsy is not known, it is often related to exposure to a viral infection.

Viruses that have been linked with Bell's palsy include the viruses that cause the following conditions:

• Cold sores and genital herpes (herpes simplex)
• Chickenpox and shingles (herpes zoster)
• Mononucleosis (Epstein-Barr)
• Cytomegalovirus infections
• Respiratory illnesses (adenovirus)
• German measles (rubella)
• Mumps (mumps virus)
• Flu (influenza B)
• Hand-foot-and-mouth disease (coxsackievirus)

In Bell's palsy, it is thought that the nerve that controls your facial muscles, which passes through a narrow canal on its way to your face, becomes swollen and inflamed as a reaction to a viral infection.

This leads to a pressure inside the canal causing ischemia (restricted blood flow and oxygen to the nerve cells).

In mild cases, only the myelin sheath of the nerve gets damaged, because of which these cases recover fast.

There is no specific test to diagnose Bell's palsy. Your doctor will make a diagnosis through physical examination.

During a physical exam, your doctor will carefully examine your face and ask you to move your facial muscles by performing certain activities such as closing your eyes, lifting your eyebrow, showing your teeth, and frowning.

Other conditions such as a stroke, infections, Lyme disease, and tumors may mimic Bell's palsy as these also cause facial muscle weakness.

You may initially consult your family doctor or a general practitioner. However, sometimes when you call to set up an appointment, you may be referred immediately to a neurologist.

It is good to be prepared for your appointment. Here is some information that may help you to get ready.

Write down the symptoms you have. Be sure to include the ones that may seem unrelated to the reason for your appointment.

Write down key personal information such as major stresses or any life changes recently.

Make a list of all your regular medications. Include the dosage schedule, and also mention any vitamins or supplements that you are taking.

Ask a family member or a friend to accompany you, if possible. Sometimes, you may find it difficult to remember all the information given during an appointment.

Someone who accompanies you may remember something that you missed or forgot.

Write down questions you want to ask your doctor. Prepare a list of questions in advance.

Some basic questions to ask your doctor include:

• What is the most likely cause of my symptoms?
• Are there any other possible causes for my symptoms?
• What kind of diagnostic tests do I need?
• Is this condition a temporary or long lasting one?
• What kind of treatments are available for Bell's palsy?
• Which do you suggest?
• Are there any alternatives to the primary approach that you have recommended?
• How can I best manage my other health conditions together?

Be prepared to answer the questions your doctor may ask, which include:

• When did you notice your symptoms first?
• Have your symptoms been continuous or occasional?
• Are your symptoms severe?
• Is there anything that seems to improve or worsen your symptoms?
• Does anybody in your family have Bell's palsy or problems with facial paralysis?

What you can do in the meantime:

If you have facial pain: Take over-the-counter pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) to ease your pain.

Apply moist heat: Place a washcloth soaked in warm water on your face several times in a day to get some relief from pain.

If your eye does not close completely, follow these tips:

• Use your finger to close your eye repeatedly throughout the day.
• Use lubricating eye drops.
• Wear eyeglasses during the day to protect your eye.
• Wear an eye patch at night.

To determine the cause of your symptoms, your doctor may recommend other tests such as:

Electromyography (EMG): This test confirms the presence of nerve damage and determines its severity.

An EMG can measure the electrical activity of a muscle in response to a stimulation and the nature and speed of the conduction of electrical impulses through a nerve.

Imaging scans: Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed at times to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture.

Most people with Bell's palsy recover completely with or without treatment.

There is no definitive treatment for Bell's palsy, but your doctor may prescribe certain medications and physical therapy to accelerate your recovery. Surgery is rarely recommended.

Medications: Most commonly used medications to treat Bell's palsy include:

Corticosteroids such as prednisone are powerful anti-inflammatory agents. These can reduce the swelling of the facial nerve and work best if they are started within few days of the appearance of your symptoms.

Antiviral drugs: The role of antiviral agents is not yet established. Antivirals, when given alone have shown no benefit over placebo.

Antivirals, when combined with steroids are also unlikely to be beneficial. However, valacyclovir (Valtrex) is sometimes given in combination with prednisone in conditions of severe facial palsy.

Physical therapy: Paralyzed muscles can shrink and reduce in length, causing permanent contractures.

A physical therapist can teach certain exercises and ways to massage your facial muscles to avoid such complications.

Surgery: Earlier, decompression surgery was performed to relieve the pressure on the facial nerve by opening the bony passage through which the nerve passes.

But now, decompression surgery is not recommended. Injury to the facial nerve injury and permanent loss of hearing loss are the risks associated with this surgery.

Rarely, plastic surgery may be advised to correct long-lasting facial nerve problems.

Although there is very little scientific evidence to support the use of alternative remedies in patients with Bell's palsy, some people may derive benefit from the following:

• Relaxation techniques: Relaxation achieved through techniques such as meditation and Yoga helps in relieving muscle tension and chronic pain.
• Acupuncture: Insertion of thin needles into specific points in your skin stimulates the nerves and muscles, which may offer some relief.
• Biofeedback training: This teaches the method to use your thoughts to control your body. Through this, you may gain better control over your facial muscles.
• Vitamin therapy: Vitamins B12, B6, and zinc supplementation may help in nerve growth.

Lifestyle modifications are necessary in order to cope with Bell's palsy.

The prognosis of Bell’s palsy is usually good. The recovery period may vary depending on the severity of damage caused to the nerves.

Generally, improvement occurs within two weeks of the initial onset of symptoms. During this period, you can take some self-care steps at home, which include:

Protection of the eye that cannot be closed: Use a lubricating eyedrops during the day and apply an eye ointment at night to keep your eye moist.

Wear glasses or goggles during the day and an eye patch at night to protect your eye from foreign objects or to avoid getting poked or scratched.

Take over-the-counter pain relieving medications: Aspirin, ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) may help relieve your pain.

Apply moist heat: Placing a washcloth soaked in warm water on your face several times in a day may help ease your discomfort.

Physical therapy exercises: Doing facial massage and exercises according to your physical therapist's advice helps in relaxing your facial muscles.

The risk of developing Bell's palsy is greater for people with following conditions:

• Pregnancy, especially during the third trimester, or during the first week of the post-partum period
• An upper respiratory infection, such as common cold or flu
• Diabetes
• Genetic predisposition to Bell's palsy
• Family history of recurrent attacks

A mild case of Bell's palsy normally resolves within a month, but recovery from a more severe case involving total paralysis varies.

Some potential complications that may occur include:

• Irreversible damage to your facial nerve.
• Misdirected regrowth of nerve fibers, which cause involuntary contraction of certain muscles when you are actually trying to move others (synkinesis). For example, when you smile, the eye on the affected side closes.
• Partial or complete blindness in the eye that does not close. It occurs due to excessive dryness and scratching of the cornea or the clear protective covering of the eye.