Bell’s Palsy

Neurological

Bell’s palsy is a sudden onset of facial paralysis that causes one side of the face to droop. If you have Bell’s palsy, you most likely went to bed and woke up the next morning to find you cannot move one side of your face. Bell’s palsy is the most common cause of facial paralysis occurring in around 40,000 people in the U.S. every year. The condition is named after the surgeon in Scotland that discovered it, Sir Charles Bell. The partial paralysis is caused by palsy (paralysis accompanied by involuntary tremors) of the facial nerve that affects all the muscles of facial expression. The facial nerve also innervates tear and saliva glands, the muscles of a small bone in the middle ear, and communicates messages of sensation from the tongue. The symptoms of Bell’s palsy gradually go away over a few weeks, but residual muscle weakness can last for several months.

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Symptoms

The symptoms of Bell’s palsy can range from mild weakness to total paralysis. The symptoms arise suddenly and consist of:

  • Sudden weakness of one side of the face
  • Facial drooping
  • Trouble smiling
  • Trouble blinking or closing the eye on the affected side
  • Weakness on the affected side
  • Paralysis on the affected side
  • Fewer tears and saliva, or more than normal
  • Loss of taste
  • Headache
  • Sensitivity to sound in the affected ear
  • Jaw and ear pain
  • Drooling

Symptoms are usually limited to one side, but in rare instances, it may affect both sides of the face. The good news is that for most people the paralysis is temporary and resolves within weeks or a few months.

Risk Factors

  • Viral infections like HIV, thecommon cold, and influenza
  • Lyme disease
  • Family history of Bell’s palsy
  • Diabetes
  • Smoking
  • Pregnancy
  • Cancer with chemotherapy
  • High blood pressure
  • Some medications
  • Low immune system
  • Autoimmune disease

Diagnosis

Treatment for Bell’s palsy is most effective with early intervention. You must see a doctor as soon as possible if you have any symptoms listed above. There is no single test that diagnoses Bell’s palsy. The diagnosis of Bell’s palsy is based on the physical exam and medical history of symptoms. Your physician will rule out any conditions that also cause facial paralysis, including Lyme disease, tumors, or stroke. The physical exam consists of a thorough examination of your head, neck, ears, and facial muscles.

Physicians use the House-Brackmann scale to rate the severity of paralysis by examining the extent of impairment of facial expression, brow movement, and the ability to close the eye(s). This system is divided into six grades that characterize the extent of facial nerve paralysis.

  • Grade I –  normal
  • Grade II – slight facial weakness
  • Grade III – moderate dysfunction of facial muscles
  • Grade IV – severe dysfunction of facial muscles
  • Grade V – little to no ability of expression
  • Grade VI – no facial motion

It is of utmost importance that a medical professional is consulted with any symptoms of facial paralysis or drooping to rule out the possibility of a stroke.

Treatments
Bell’s palsy often goes away on its own within a couple of weeks. If the case is severe enough, the doctor may prescribe medications. Those include:

Corticosteroids. These may help to shorten the course of the illness by reducing the inflammation to the facial nerve and shortening the duration of the palsy.

Non-steroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs like NSAIDs help to relieve swelling to the nerve.

Anti-viral medications. Some studies have shown that taking anti-viral medications with corticosteroids may help reduce the effects of the virus on the nerve and shorten the time of paralysis.

Pain medications. These can help relieve jaw and ear pain.

Eye drops and patches. Since the eye will not close or blink, the eye needs to be protected from things getting inside. Blinking also keeps the eye moist, so eye drops can replace that function until the eye recovers.

Physical therapy. Facial exercises help to strengthen weakened muscles and improve eye movement.

Surgery. In extreme cases, surgery may be required to relieve the compression on the facial nerve

Treatments

Bell’s palsy often goes away on its own in about 2 weeks. If the case is severe enough, the doctor may prescribe medications. Those include:

Steroids. These may help to shorten the course of the illness by reducing the inflammation to the nerve.

Non-steroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory drugs like NSAID’s help to relieve swelling to the nerve.Anti-viral medications. Some studies have shown that taking anti-viral medications may help reduce the effects of the virus on the nerve and shorten the time of paralysis.

Pain medications. These can help relieve jaw and ear pain.

Eye drops and patches. Since the eye will not close or blink, the eye needs to be protected from things getting inside. Blinking also keeps the eye moist, so eye drops can replace that function until the eye recovers.

Alternative Treatments and Home Remedies

Acupuncture. Acupuncture is an inexpensive treatment strategy for a number of diseases, including Bell’s palsy. A recent study showed electroacupuncture to relieve the severity of symptoms.

Eat foods high in lysine. Lysine may send viruses into a dormant phase. Examples of foods that are high in lysine are meats, dairy, fish, yogurt, apples, pineapples, and asparagus.

Take B vitamins. Vitamin B nourishes the nerves and nervous system. It is thought that vitamin B supplements can speed recovery.

Try MSM. The supplement, MSM, may help to repair nerves. This can be found at your local drugstore or health food store.

Try warm, moist heat. Take a warm washcloth and place it over the affected area several times daily to help improve blood flow and lessen the pain.

Try some exercises. Do exercises with your face that involve frowning, puckering your lips, and tightening your chin. These will keep the muscles tone.

Stretch your facial muscles. Point your lips out as far as they will go, then release. Roll your head from side to side. Stretches can help relax the muscles.

Wear sunglasses during the day. Wear sunglasses during the day to protect your eye from excess sunlight and debris.

Prevention

At this time there isn’t much you can do to prevent Bell’s palsy, because the cause is unknown. There are a few preventative tips that can help keep you healthy and avoid contracting

  • the viruses that are possible risk factors:
  • Practice good hand washing
  • Avoid crowds during cold and flu season
  • Eat a healthy diet and drink plenty of fluids
  • Rest and stay home if you catch a virus
  • Avoid caffeine, smoking, and alcohol when you are sick

In general, try to keep yourself as healthy as possible, especially if you have a family history of Bell’s palsy.

References

Baugh, R. F. (2013). Clinical practice guideline: Bell’s palsy. Otolaryngology-Head and Neck Surgery, 149(3S), S1-S27. Retrieved from Sage Publishing Online: https://journals.sagepub.com/doi/pdf/10.1177/0194599813505967

MedlinePlus. (2020). Bell’s palsy. Retrieved from Medline Plus: https://medlineplus.gov/bellspalsy.html

Meštrović, T. (2019, February 26). Bell’s palsy complications. Retrieved from News Medical: https://www.news-medical.net/health/Bells-Palsy-Complications.aspx

National Institute of Neurological Disorders and Stroke. (2018, June). Bell’s palsy fact sheet. National Institute of Health. Retrieved from National Institute of Neurological Disorders and Stroke: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Bells-Palsy-Fact-Sheet

Singh, B. B., et. al. Safety and effectiveness of an L-lysine, zinc, and herbal-based product on the treatment of facial and circumoral herpes. Alternative Medicine Review, 10(2),123-127. Retrieved from: http://archive.foundationalmedicinereview.com/publications/10/2/123.pdf

Sullivan, F. M., Swan, I. R. C., Donnan, P. T., Morrison, J. M. (2007, October 18). Early treatment with prednisolone or acyclovir in Bell’s palsy. New England Journal of Medicine, 357, 1598-1607.  Retrieved from: https://www.nejm.org/doi/full/10.1056/NEJMoa072006#:~:

text=There%20were%20no%20serious%20adverse%20events%20in%20any,additional%20benefit%

20of%20acyclovir%20in%20combination%20with%20prednisolone

Tiemestra, J. D., & KhateKhate, N. (2007, October 1). Bell’s palsy: Diagnosis and management. American Family Physician, 76(7). Retrieved from: https://www.aafp.org/afp/2007/1001/afp20071001p997.pdf

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