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Bell’s Palsy

by Mary Gallagher, RN, MSN, CCRN

Apr 1, 2019
April 2019

BELL’S PALSY IS A NERVE DISORDER that usually occurs without warning. This condition happens when the nerve that controls facial muscle movement becomes swollen, inflamed or compressed. Damage to this nerve — called the facial nerve or the seventh cranial nerve — causes weakness and paralysis of facial muscles.

With approximately 40,000 U.S. cases each year, Bell’s palsy affects men and women equally and occurs at any age, although it is less common before age 15 or after age 60. It disproportionately attacks people with diabetes or upper respiratory ailments such as the flu or a cold. Infections called herpes zoster and herpes simplex might be involved. Other conditions that may cause Bell’s palsy include HIV/AIDS infection, Lyme disease, middle ear infection, mononucleosis and sarcoidosis (inflammation of the lymph nodes, lungs, liver, eyes and skin).

Bell’s palsy occurs more often in pregnant women, especially in the third trimester or in the first week after giving birth.

Some patients have a cold shortly before the symptoms of Bell’s palsy begin. Symptoms most often start suddenly but may take up to two to three days to show up. They do not become more severe after that time. Symptoms appear almost always on one side of the face only and may range from mild to severe. Many people feel discomfort behind the ear before noticing the muscle weakness. The face feels stiff or pulled to one side and may look different.

The lack of control over facial muscles can cause symptoms such as difficulty closing one eye; difficulty eating or drinking (food falls out of one side of the mouth); drooling; drooping of the face such as the eyelid and corner of the mouth; problems smiling, grimacing and making facial expressions; and twitching or weakness. Other symptoms include dry eye, dry mouth, headache if there is an infection, loss of taste, and hearing sound louder in one ear.

Call your health care provider immediately or go to the emergency department of your hospital to make sure this is not a stroke. The health care provider will take a history and perform an assessment. Blood work can determine the presence of medical problems such as Lyme disease which may cause Bell’s palsy. Sometimes an electromyography or nerve conduction test is needed to check the nerves that supply the face. You may need a CT scan or MRI of the head if your provider suspects a brain tumor may be causing your symptoms.

Often, no treatment is needed for Bell’s palsy. Symptoms may begin to improve right away, though it may take weeks or months for the facial muscles to get stronger. Your health care provider may prescribe lubricating eye drops or ointment to keep the surface of the affected eye moist if you cannot close it completely. You may need to wear an eye patch while you sleep or during the day.

Your provider may prescribe medications such as corticosteroids (prednisone) which may reduce swelling around the facial nerve. Other medications include valacyclovir to fight the virus that may cause the condition. Physical therapy, facial massage therapy or acupuncture may be prescribed.

Complications of Bell’s palsy include corneal abrasions, infections and vision loss because the eye surface is dry, or swelling in the muscles due to loss of nerve function.

When first diagnosed with Bell’s palsy, it is important to get plenty of rest even if you have no other symptoms. You should also maintain a healthy diet. If you work or attend school, it may be necessary to take time off to recover. Eye care is important. Excessive watering of the eye may be a sign of a dry eye problem. Eating and drinking may be difficult in the early stages. When your face is not working as it should, it is tempting to try to force the muscles back to work by doing facial exercises. Do not carry out exercises without professional help, as you may do more harm than good. Gently massaging your facial muscles is helpful.

Most cases go away completely within a few months. If you do not lose all your nerve function and symptoms begin to improve within three weeks, you are more likely to regain all or most of your strength in your facial muscles. Some people may continue to experience long-term changes in taste, spasms of the eyelid muscles or facial muscle weakness.

There is no way to prevent Bell’s palsy. It is rare for it to recur; but if it does, you may have a family history of recurrent attacks, suggesting a possible genetic predisposition to Bell’s palsy.

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.

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