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Bell's Palsy

Definition

Bell's palsy is a sudden weakness or paralysis on one side of the face which may occur without an obvious explanation. However, it is usually a temporary condition. Recovery rate decreases with increasing age.
Bell's Palsy: Facial Droop
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Causes

The exact cause of Bell's palsy is unknown. It is thought to be a result an infection or inflammation in the nerve.
Nerve infections include:

Risk Factors

Factors that may increase your risk of Bell's palsy include:

Symptoms

Bell's palsy symptoms may come on suddenly or develop over a few days. Initial symptoms may include:
  • Pain behind the ear that is followed by weakness and paralysis of the face
  • Ringing sound in the ears
  • Slight hearing impairment
  • Slight increase in sensitivity to sound on the affected side.
Symptoms of full-blown Bell's palsy may include:
  • Facial weakness or paralysis, most often on one side
  • Numbness just before the weakness starts
  • Drooping corner of the mouth
  • Drooling
  • Decreased tearing
  • Inability to close an eye, which can lead to:
    • Dry, red eyes
    • Ulcers forming on the eye
    • Infection
  • Problems with taste on one side
  • Sound sensitivity in one ear
  • Earache
  • Slurred speech
Late complications can occur 3-4 months after onset and can include:
  • Long-lasting tightening of the facial muscles
  • Tearing from eye while chewing
Symptoms will often go away on their own within a few weeks. Bell's palsy may completely resolve after a few months in many people. In some cases, some symptoms of Bell's palsy may never go away.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis is usually made with just the physical exam. The doctor may use information from your health and medical history to determine a potential cause.
Concern about infections or other specific causes may require further testing.

Treatment

For most, treatment is not needed. Your doctor may refer you to a specialist if you have eye problems, if your symptoms worsen, or if your recovery takes longer than expected.
If an underlying cause of the Bell's palsy is known, it may be treated. Treatment for underlying conditions may include medication or surgery.

Medication

Your doctor may prescribe corticosteroids if your symptoms have been present for a short time. This is a medication that can decrease swelling and pain.
Antiviral medications along with corticosteroids may be recommended. There is no evidence that antiviral medication alone has any benefit.

Self-care

If the paralysis includes your eyelid, you may need to protect your eye. This may include:
  • Lubricant or eye drops
  • Covering and taping eye closed at night
  • An eye patch to keep the eye closed
Massaging of the weakened facial muscles may also help.

Therapy

Physical therapy may be advised to improve function.
Symptoms can be very distressing. Counseling can help you manage emotional issues and make appropriate adjustments.

Prevention

There are no current guidelines to prevent Bell's palsy.

RESOURCES

Centers for Disease Control and Prevention http://www.cdc.gov

National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Public Health Agency of Canada http://www.phac-aspc.gc.ca

References

Bell's palsy . American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/bells-palsy.html. Updated April 2014. Accessed May 30, 2014.

Bell's palsy. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/?q=node/1465. Updated February 2013. Accessed May 30, 2014.

Bell’s palsy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 7, 2014. Accessed May 30, 2014.

Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngology. 2008;265:743-752.

Grogan PM, Gronseth GS. Practice parameter: steroids, acyclovir, and surgery for Bell’s palsy (an evidence based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56:830-6.

NINDS Bell’s palsy fact sheet. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/disorders/bells/bells.htm. Updated April 16, 2014. Accessed May 30, 2014.

Quant EC, Jeste SS, Muni RH, et al. The benefits of steroids versus steroids plus antivirals for treatment of Bell's palsy: a meta-analysis. BMJ. 2009;339:b3354.

11/6/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Sullivan FM, Swan IR, Donnan PT, Morrison JM, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med. 2007;357:1598-1607.

1/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Engstrom M, Berg T, Stjernquist-Desatnik A, et al. Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet Neurol. 2008;7:993-1000.

9/15/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Goudakos JK, Markou KD. Corticosteroids vs corticosteroids plus antiviral agents in the treatment of Bell palsy: a systematic review and meta-analysis. Arch Otolaryngol Head Neck Surg. 2009;135:558-564.

9/15/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: de Almeida JR, Al Khabori M, Guyatt GH, et al. Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. JAMA. 2009;302:985-993.

2/13/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Baugh BF, et al. Clinical Practice Guideline: Bell's Palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-27.

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