Bell’s Palsy

Bell’s palsy is a condition that causing sudden muscle weakness one side of the face (most of the time on the right side (63% of the time). A temporary condition, Bell’s Palsy makes half of the face appear to droop, and smiles are one-sided, and eye on the affected side is hard to close.

Bell’s palsy is the most common cause of acute unilateral (one sided) facial paralysis, accounting for approximately 60-75% of such cases.

What are the symptoms of Bell’s Palsy?

Symptoms occur suddenly, where one sleeps at night feeling fine and wakes up in the morning with one side of your face weak or drooping. These symptoms may include –

• Mild weakness to total paralysis on one side of the face
• Facial droop and trouble making facial expressions, such as closing an eye or smiling.
• Drooling.
• Pain around the jaw or pain in or behind the ear on the affected side.
• Increased sensitivity to sound on the affected side.
• Ringing in the ears on the affected side (tinnitus)
• Headache.
• Loss of taste.
• Changes in the amount of tears and saliva produced.
• Low tolerance for loud sounds
• Difficulty talking
• Trouble eating and drinking

What are the causes and risk factors of Bell’s Palsy?

Bell’s palsy is known to be caused by damage to the facial nerve, resulting in swelling. This facial nerve passes through a narrow, bony area in the skull, which when swollen, pushes against skull’s hard surface, affecting how well the nerve works.

The nerve damage may occur owing to many reasons, but viral infection is the most common cause. Viruses that have been linked to Bell’s palsy include viruses that cause:

• Cold sores and genital herpes
• Chickenpox and shingles
• Infectious mononucleosis (Epstein-Barr virus)
• Cytomegalovirus infections.
• Respiratory illnesses, caused by adenoviruses.
• German measles (rubella)
• Mumps (mumps viru)
• Flu virus
• Hand-foot-and-mouth disease, caused by a coxsackievirus.

Risk factors for Bell’s Palsy are –

• Diabetes
• A respiratory infection, such as a cold or the flu
• An autoimmune disease
• Cold sores
• High blood pressure
• Mononucleosis
• Shingles
• Obesity
• Preeclampsia, a type of high blood pressure that happens during pregnancy

How is Bell’s Palsy diagnosed?

Physical exam is the best way for diagnosis of Bell’s palsy as there is no defined lab test.  The doctor examines the face and asks the person to make different facial expressions to assess the action of muscles. Most doctors diagnose based on the symptoms, but they also rule out other conditions such as stroke, middle ear infection, and tumours.

To rule out other health problems causing facial paralysis, the doctor might order tests such as:

• Blood tests.
• Electromyography (EMG) – checking nerve activity and assessing paralytic situation.
• Magnetic resonance imaging (MRI) or computed tomography (CT) scans to eliminate other problems causing paralysis.

What are the treatment options for Bell’s Palsy?

People with Bell’s palsy mostly recover fully, either with or without treatment. But the healthcare professional may suggest medicines or physical therapy to help speed recovery, with surgery a rare option in case of Bell’s palsy.

• Corticosteroids (such as prednisone): May help ease swelling of facial nerve
• Antiviral drugs (such as acyclovir and valacyclovir): In combination with corticosteroids, typically in severe cases of Bell’s palsy.
• Eye drops: If a person’s ability to blink and closing the eye is affected, eye drops, or ointment are recommended to keep it moist. Because there is trouble closing the eye, a person should wear glasses or goggles during the day and an eye patch at night to protect your eye from getting poked or scratched
• Surgery. Surgery is usually a last resort if your symptoms don’t go away, or if you have complications.
• Physical therapy:  A physical therapist is necessary to teach a person to massage and exercise facial muscles that often shrink and shorten due to paralysis.

References:

1. Dr. Meštrović T, Bell’s Palsy Epidemiology. News-Medical.Net. May 2024 https://www.news-medical.net/health/Bells-Palsy-Epidemiology.aspx
2. Bell’s Palsy. Mayo Clinic. May 2024. https://www.mayoclinic.org/diseases-conditions/bells-palsy/symptoms-causes/syc-20370028
3. What Is Bell’s Palsy? WebMD. May 2024. https://www.webmd.com/brain/understanding-bells-palsy-basics