Bell Palsy is the most common cause of facial weakness on one side of your face. The facial weakness can start acutely over a 48 hour period. Although not being able to move your face can be scary, fortunately 80-90% of cases resolve spontaneously with time. However, you should still seek medical attention as soon as possible to exclude other more ominous causes like a stroke. Let’s dive in and learn what you can do when you develop Bell’s palsy.
What Causes Bell Palsy
The cause of Bell palsy remains unknown but appears to be a result of inflammation, edema, and ischemia of the facial nerve from a viral infection. Many researchers believe herpes simplex virus type (HSV), the same virus responsible for cold sores, is a possible cause of Bell palsy. Other possible viral causes include herpes zoster, HIV, Lyme, and syphilis. Recently, SARS-CoV-2 virus responsible for COVID-19 as well as the Coronavirus vaccine have been associated with Bell palsy.
Similar in presentation to Bell palsy, Ramsay Hunt Syndrome is caused by varicella-zoster virus infection of the facial nerve and vesicular rash around the ear. Justin Bieber was diagnosed with Ramsay Hunt Syndrome in June 2022.
Symptoms of Bell Palsy
The symptoms of Bell palsy appear suddenly and rapidly, peaking within 48 hours. Besides facial weakness, there are other symptoms from Bell palsy. The facial weakness can begin during sleep but you may first notice it in the morning. You should seek medical attention immediately for evaluation and treatment.
- Weakness in forehead, eye closure and mouth. Differently, a stroke causes weakness in the lower face and spares the upper face.
- Ear pain
- Decreased tears and dry eyes
- Blurred vision
- Sensitive hearing
- Taste changes
- Numbness and tingling on cheek
Diagnosis of Bell Palsy
The diagnosis of Bell palsy begins with a detailed history and neurological examination to exclude other causes of your facial weakness. There is no specific testing for the diagnosis of Bell palsy. Your doctor may order an MRI brain to exclude a stroke or tumor if your symptoms last longer than 6-8 weeks. Laboratory testing may be ordered to exclude diabetes, thyroid disease, HIV, syphilis, lyme, and autoimmune disease.
Treatment for Bell Palsy
Approximately 80-90% of cases recover without noticeable weakness within 6 weeks to 3 months. Risk factors for poorer recovery include age greater than 60 years, complete paralysis, and decreased taste or saliva on the weak side. Approximately 30% of people have long-term symptoms with 5% of people having unacceptable noticeable weakness. Bell palsy can recur in 4-14% of cases.
Medication treatment may not be necessary as most people recover spontaneously. Treatment is aimed at reducing facial nerve damage and improving function. Medication treatment can be started within 1-4 days but chances of complete recovery if started within 48 hours of symptoms. High-dose corticosteroids can be effective in recovering facial nerve function. It is reasonable to add antiviral medicines to corticosteroids, but antiviral medicines should not be used alone as there is no benefit.
Physical therapy may help with recovery of facial weakness. Occupation and speech therapy can help with eating and drinking problems.