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Johns Hopkins Symptoms and Remedies

Johns Hopkins Medicine

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Bell's Palsy

What is it?

Bell's palsy is paralysis of the muscles on one side of the face. It results from inflammation of the facial nerve, which runs through a tiny hole in the bone between the ear and the jaw. Inflammation of this nerve compresses it inside its bony channel, thus paralyzing the muscles between the forehead and mouth. Most often, Bell's palsy isn't serious and symptoms, such as drooping facial muscles, spontaneously resolve on their own. However, severe cases of Bell's palsy can lead to serious eye injury resulting from drying out of the cornea. Onset is usually sudden, typically occurring upon awakening. The disorder most commonly strikes those between the ages of 30 and 60.

What Causes It?

  • The cause is unknown in most cases.
  • Viral infection (including herpes zoster, the same virus that causes chicken pox and shingles), physical trauma, and heredity have been proposed as potential causative factors.

Prevention

There is no way to prevent Bell's palsy at present.

Diagnosis

  • Physical examination is necessary. Other disorders, such as a stroke, will have to be ruled out.
  • Electrical tests of the facial nerves (electromyography) may be performed to determine the extent of nerve damage.

How to Treat It

  • Spontaneous recovery occurs in 80 to 90 percent of cases (often beginning within three weeks), so many physicians believe treatment is unnecessary or ineffective. Outlook is most favorable when paralysis is incomplete and improvement begins soon after onset. Treatment is thus aimed at easing symptoms and preventing damage to the eye.
  • Many physicians will prescribe a short course of prednisone along with an antiviral medication (such as lamcyclovir) for patients who have experienced symptoms for less than 48 hours. After 48 hours, however, these medications are not effective, so patients should consult a doctor as soon as symptoms appear.
  • Wearing goggles during the day and applying an eye patch at night to hold the eyelid shut may help protect the eye if the eyelid cannot close. Treatment with an artificial tear solution during the day and an ophthalmic ointment at night may also be advised.
  • Nonprescription pain relievers and using a heating pad on the painful area for 15 minutes at a time eases mild to moderate pain.
  • For cases that f ail to improve over time, corticosteroids (such as prednisone) may be prescribed—although the effectiveness of such therapy for Bell's palsy is a point of debate.
  • As muscle strength returns, exercising the weak facial muscles is recommended.
  • Plastic surgery may improve appearance and muscle function in the rare cases where facial paralysis persists.

When to Call a Doctor

  • Facial paralysis always warrants a doctor's attention. Although Bell's palsy is the most common cause and is not a medical emergency, more serious problems such as a stroke or tumor should be ruled out.