Bell's palsy is a sudden weakness or paralysis on one side of the face. It is
usually a temporary condition.
Bell's Palsy: Facial Droop
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The exact cause of Bell's palsy is unknown. It is thought to be a result of an infection or inflammation that affects the nerve.
Examples include: Lyme disease
Factors that may increase your risk of Bell's palsy include: Family members who have Bell's palsy
Infections, such as
Lyme disease, HIV,
fluSuppressed immune systemChemotherapyCertain medicationsPregnancySmokingHigh blood pressure
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 faceRinging sound in the earsSlight hearing impairmentSlight increase in sensitivity to sound on the affected side
Symptoms of advanced Bell's palsy may include: Facial weakness or paralysis, most often on one sideNumbness just before the weakness startsDrooping corner of the mouthDroolingDecreased tearing
Inability to close an eye, which can lead to:
Dry, red eyesUlcers forming on the eyeInfectionProblems with taste on one sideSound sensitivity in one earEaracheSlurred speech
Late complications can occur 3-4 months after onset and can include: Long-lasting tightening of the facial musclesTearing from eye while chewing
Symptoms will often go away on their own within a few weeks. Bell's palsy
may resolve after a few months in many people. In some cases, some symptoms of Bell's palsy may never go away. The recovery rate decreases with increasing age.
You will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis is usually made with just the physical exam. Information from your health and medical history may be used to determine a potential cause.
Concern about infections, cancer, or other specific causes may require further testing. Tests may include: CT scanMRI scanLumbar puncture
For most, treatment is not needed. You may be referred 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.
Your doctor will likely prescribe
corticosteroids if your symptoms have been present for a short time.
Antiviral medications along with corticosteroids may be advised. There is no evidence that antiviral medication alone has any benefit.
If the paralysis includes your eyelid, you may need to protect your eye. This may include: Lubricant or eye dropsCovering and taping your eye closed at nightAn eye patch to keep the eye closed
Massaging the weakened facial muscles may also help.
Physical therapy may be advised to improve function.
Symptoms can be distressing. Counseling can help you manage emotional issues and make appropriate adjustments.
There are no current guidelines to prevent Bell's palsy.
Bell's palsy . American Academy of Family Physicians Family Doctor website.
http://familydoctor.org/familydoctor/en/diseases-conditions/bells-palsy.html. Updated April 2014. Accessed August 28, 2015.
American Academy of Otolaryngology—Head and Neck Surgery website. Available at:
http://www.entnet.org/?q=node/1465. Updated February 2013. Accessed August 28, 2015.
Bell’s palsy. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed. Updated August 17, 2015. Accessed August 28, 2015.
Finsterer J. Management of peripheral facial nerve palsy.
Eur Arch Otorhinolaryngol.
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.
Bell’s palsy information page. National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/bells/bells.htm. Updated April 16, 2015. Accessed August 28, 2015.
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.
Schwartz SR, Jones SL, Getchius TS, Gronseth GS. Reconciling the clinical practice guidelines on Bell’s palsy from the AA-HNSF and the AAN. Neurology. 2014;82(21):1927-1929.
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(16):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.
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.
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.
2/13/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Baugh BF, Basura GJ, Ishii LE, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013;149(3 Suppl):S1-S27.
Last reviewed August 2015 by Rimas Lukas, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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