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BELL'S PALSY

What is Bell's Palsy?

Bell's palsy is the name used for facial paralysis or weakness for which no obvious cause is found. It is a common and benign nerve disorder. It is caused by damage to the facial nerve on one side. There is often pain around the ear at first, followed by weakness of the face muscles. This causes the eye to stop blinking and prevents the eye closing during sleep. The corner of the mouth often droops. Noises may seem excessively loud and taste may be affected. The face may seem a bit numb although feeling over the face is not usually affected. The weakness often gets worse over a period of a few days. A variety of conditions can cause facial nerve damage so it is important that you are examined by a doctor and report any other symptoms or problems. Weakness of the face associated with an ear infection or a rash is not due to Bell’s palsy.

How does Bell's Palsy occur?

This nerve conveys signals from the brain to the muscles of the face, as well as to a muscle in the ear and some taste messages from the tongue to the brain. It passes through a canal in the bone of the skull. Something causes it to become inflamed and to swell. Many cases are thought to result from a common virus.

Why does Bell's Palsy occur?

No definite reasons have been found but it can occur at any age and is more common in pregnant women, people with diabetes (even if not previously diagnosed) and those suffering from a cold. Although often suspected, it is not due to draughts from an open window.

What does treatment involve for Bell's Palsy?

If your array of symptoms suggests that the condition is more complicated than Bell’s palsy, your doctor may do various tests. In a very small number of cases, the damage is so severe that the face is completely paralysed. In a small proportion of these, it never recovers. Steroids (cortisone-like drugs) given as tablets for a week or so, may reduce the risk of this happening. If you see a doctor while the weakness is still developing or when it is severe, you may be given steroids. Once the weakness has stopped getting worse or if it is only mild, steroids are not usually given. Some people feel better for some regular facial massage or exercise, and physiotherapy will stimulate the muscles electrically to try to keep them active. Some doctors recommend a splint which hooks over the ear and into the mouth to support the droop of the mouth. Treatment is usually not necessary however, because the weakness recovers in a few weeks or months and almost never lasts for more than a year.

What to watch out for during treatment of Bell's Palsy?

Steroids can cause side effects such as acne, insomnia or agitation but since they are stopped within a week or two, no long lasting effects are likely. In diabetics, the blood sugar level may be raised. This can be caused by the steroid treatment, or possibly was there beforehand: a change in treatment may be called for. There is often a frustrating period of a few weeks or even months when nothing seems to be improving. Once improvement begins, it is usually well sustained and more than 90% of patients are satisfied with the degree of eventual recovery.

What to watch out for after treatment of Bell's Palsy

Sometimes, as the nerves recover, they start to activate the “wrong” muscles in the face. The eye may shut when eating or the face may twitch when a blink occurs. This usually corrects itself spontaneously. The majority of people never have another attack but occasionally it may recur and recover for the second time. If the recovery is unsatisfactory, injection treatment or plastic surgery may be considered to improve the appearance of the face.

What would happen if Bell's Palsy was not treated?

Bell’s palsy will recover even without treatment in the vast majority of cases. Other causes of facial palsy may require treatment of the underlying disease.

What is involved for family and friends of Bell's Palsy sufferers?

The condition is not infectious and although many people will find that someone else in the family has had Bell’s palsy, it is not hereditary. You might feel very self-conscious and embarrassed by the weakness and a lot of support and encouragement will be needed.