Bell's Palsy

Definition
Bell's palsy is a sudden weakness and paralysis on one side of the face. It occurs in approximately 40,000 Americans each year and affects men and women equally.
Bell's Palsy: Facial Droop

Causes
The cause of Bell's palsy is unknown. It is suspected that an irritated facial nerve becomes swollen due to inflammation. As the facial nerve passes through narrow openings in the skull, it is compressed and symptoms result. Doctors believe a herpes virus may cause the nerve to become inflamed. Head or facial injuries; tumors; strokes; abscess; HIV infection; autoimmune disease; drug therapy such as chemotherapy; hereditary diseases, or other medical problems may also cause paralysis of the facial nerve.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for Bell's palsy include:
• Family members who have Bell's palsy
• Pregnancy
• Diabetes
• Cold or flu
• Weakened immune system
• Age
• Smoking
• Hypertension
• Ear infection
• HIV infection
• Head or facial trauma
• Cancer history
Symptoms
Bell's palsy symptoms may come on suddenly or develop over a few days. Initial symptoms may include:
• Pain behind the ear that precedes the weakness and paralysis
• Ringing sound in the ears
• Slight fever
• Slight hearing impairment
Symptoms of full-blown Bell's palsy may include:
• Facial weakness or paralysis:
o Usually on one side
o Forehead is smooth
o Not able to smile
• Numbness just before the weakness starts
• Drooping corner of the mouth
• Drooling
• Tearing
• Inability to close an eye, which can lead to:
o The eye becoming red and dehydrated
o Ulcers forming on the cornea
o Infection
o Possible loss of the eye
• Dry eye
• Impaired taste
• Sound sensitivity in one ear
• Earache
• Slurred speech
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.
Other tests may include:
Hearing Test—to see if nerve damage involves the hearing nerve, inner ear, or hearing mechanism
Balance Test—to see if balance nerves are involved
Lumbar Puncture—to rule out meningitis, autoimmune disorders, or metastasis from a tumor
Tear Test—measures the eye's ability to produce tears
CT or MRI Scan—to see if there is an infection, tumor, bone fracture, or other problem in the area of the facial nerve
Electrical Test—to see how badly the facial nerve is damaged
Blood Tests—to check for diabetes, HIV infection, or Lyme disease
Treatment
In most cases, symptoms go away within a few weeks without treatment. Many cases of Bell's palsy completely resolve after a few months. Steroids are commonly used, sometimes in combination with an antiviral drug (Acyclovir). Protecting the eye is also important, because people with Bell’s palsy may not be able to blink. If an underlying cause of the symptoms is known, it is treated. For some patients, however, symptoms may never go away.
Medication
• Corticosteroids or nonsteroidal anti-inflammatory drugs (NSAIDs)—to reduce inflammation and pain
• Antibiotic or antiviral drugs—if infection is the cause
Surgery
Some doctors try to surgically relieve pressure on the nerve by removing part of the bone. This is an unproven procedure that is considered controversial and is no longer commonly performed. If the eyelid will not close, other surgeries around the eye may be considered.
Self-care
Patients may need to apply lubricant or put drops in the eye. The eye can be covered and taped closed at night. Do not place tape directly on the eyelid. An eye patch may be worn to keep the eye closed. This helps moisten and keep particles out of the eye. Massage of the weakened facial muscles may be beneficial.
Therapy
Most patients who do not recover are distressed by their symptoms. They may need help dealing with the emotional issues associated with the condition.
Prevention
There are no guidelines for preventing Bell's palsy because the cause is unknown and there are no tests to detect it before symptoms begin. If you think you are at risk for Bell's palsy, talk to your doctor about ways to reduce your risk factors.