Medically Verified By: Dr. Sandeep Borse
Bell's palsy, a neurological disorder, may affect men and women of any age, but statistics suggest that the condition is more likely to strike those above forty. Diabetics and people with a compromised immune system are at a greater risk of suffering from the condition. Other factors that can up your risk of Bell's palsy include pregnancy, lung infection and a family history of the condition.
Bell's palsy is a condition that leads to temporary weakness or paralysis of the facial nerves. Inflammation or compression of the nerves responsible for controlling the muscles of your face can trigger this condition. Bell's palsy causes one side of your face to sag or become stiff. So, your lip and eye movements become restricted on the side of your face affected by this condition. Named after Scottish anatomist Charles Bell, the first to be affected by Bell's palsy, this condition doesn't last for long. The symptoms resolve within a few weeks. Rarely, it relapses.
The symptoms of Bell's palsy appear abruptly a week or two after you've suffered cough and cold, ear or eye infection. You may experience them after getting up from bed in the morning or while trying to eat or drink. Watch out for these symptoms of Bell's palsy and consult a doctor:
Causes
The exact cause of Bell's palsy is yet to be known. Bell's palsy is usually caused by inflammation of a facial nerve at the point where it exits the skull to enter the face. So, commonly, it affects the ears. The inflammation can be the result of a viral infection or a tumour. However, the onset of facial muscle weakness due to a tumour is usually gradual and not sudden.
Several viruses and bacteria have been associated with Bell's palsy. Here are the most prominent ones:
Herpes simplex: It causes cold sores and genital herpes
HIV: It damages the immune system
Herpes zoster: It causes chickenpox and shingles
Rubella: It causes German measles
Mumps virus: It causes mumps disease
Influenza B: It gives you flu
Adenovirus: It causes respiratory virus
Risk Factors
[Risk factors for the development of Bell's palsy are individuals of age greater than 60 years. Complete paralysis and decreased salivation or taste associated with the ipsilateral side. Other risk factors of bell palsy are pregnancy, pre-eclampsia, obesity, diabetes and hypertension.
The best way to prevent this condition is to keep your immunity up and prevent infections. Since this condition is also brought on by sudden or prolonged exposure to cold, avoiding extremely cold liquids is an effective way to keep Bell's palsy at bay. People should also avoid driving in cold weather since their face is exposed to cold winds. However, if you must, protect your face and ears with a scarf to stay safe from this condition.
The diagnosis of Bell's palsy is purely clinical. Your doctor will ask you about the symptoms and discern the onset of the condition. He may also suggest physical and neurological tests to confirm the diagnosis based on his physical examinations. These tests may include bloodwork for detecting bacterial or viral infection, MRI or CT scan to check the nerves of your face.
Physical examination and history evaluation guide the diagnosis of Bell's palsy. The House-Brackmann facial nerve grading system can describe the degree of facial nerve weakness. Diabetic testing is not mandatory to be performed. The degree of the facial nerve in inflammation can be detected with magnetic resonance imaging (MRI). Magnetic resonance imaging can also be used to rule out condition such as haemangioma, space-occupying lesion or schwannoma.
In patients with severe blood pressure, electromyography (EMG) and nerve conduction studies are used. Electroneurography is used to detect the difference between facial muscles. Audiography is suggested if hearing loss is suspected. Another test, such as nerve excitability, saliva flow, and tear function, are also performed.
In most cases, Bell's palsy heals on its own without any treatment. However, if you need medical intervention, your doctor may prescribe medicines to tackle inflammation and suggest physiotherapy. Oral drugs may include corticosteroid drugs to work on inflammation, antibiotics (in case the culprit is any pathogen) and pain relievers. Physiotherapy, on the other hand, may help you stimulate the weakened facial nerves. Also, a patient will be advised to use re-wetting eye drops to prevent the onset of dry eyes. In this condition, the eyelids will not be able to close completely, thus causing dryness. You may also be suggested to wear protective glasses to prevent damage to the eyeball due to foreign objects.
Corticosteroids are available in 60 mg to 80 MG dose once a day, and these medications should be taken for approximately one week. Antiviral drugs such as valaciclovir 1000mg/day for five days and acyclovir 400mg five times a day for five days are given to treat Bell's Palsy. A combination of antivirals and steroids can be used as a combination therapy in patients with severe facial nerve palsy. To reduce the likelihood of corneal aberration, patients should use eye lubrication at bedtime.
Surgical interventions can be considered if the symptoms do not improve after weeks or months of therapy. Depending upon the case of the patient facial nerve decompression can be performed. However, facial nerve decompression is not recommended treatment option.
Non-pharmacological therapies also included in the treatment of Bell's palsy. Acupuncture to affected muscles, massage, facial exercises, electrical stimulation and thermotherapy have been associated with a reasonable recovery rate. Improvement of facial function has been noted in moderate to chronic paralysis patients due to facial exercises. Initiating facial activities in the early stages have been proved to reduce the recovery time. Surgical treatment has also been considered for facial nerve paralysis, but this procedure's success rate is meagre.
Even though Bell's Palsy usually resolves in due course of time, it is important to take medicines as directed by the doctor. It is also essential to ensure that there are no long-term complications and proper care is taken. For example, if one's eyes are affected, using eye drops during the day and ointment at bedtime can protect the cornea from scratching.
Prognosis
Symptoms associated with Bell's palsy range from mild weakness to severe paralysis. The prognosis for people with Bell's palsy is usually positive. Typically, people see improvements two weeks after the onset of symptoms and get cured within three to six months. However, recovery time varies with the severity of nerve damage. On rare occasions, this condition relapses. Copenhagen facial nerve study studied the effects of treatment on the patients. They found that 71 per cent of patients recover without the treatment, four per cent of patients were experiencing severe weakness leading to significant facial dysfunction, and about 13 per cent are found with slight weakness. The House-Brackmann scale is used as a scoring system for monitoring the treatment of Bell's Palsy. According to a randomised controlled trial, the recovery rate is significantly higher in moderately severe patients at onset than those with severe Bell's palsy. Recurrence in the ipsilateral and contralateral region was found in 7% of patients with equal incidence. There is not enough data for determining whether the treatment of Bell's Palsy affects its recurrence rate.
Complications
Though Bell's palsy is a condition that resolves pretty easily in most cases, people with a severe form of this condition may experience the following complications:
Side-effects of covid vaccine: People are facing the problem of facial paralysis, claims study
Scientists have identified a protein that may cause muscle weakness as you age. But this can happen also due to a sedentary lifestyle or certain health conditions. Read on to know more.
Bell's Palsy is a type of facial paralysis that results in an inability to control the facial muscles on the affected side.
Here are all your questions about Bell's Palsy answered by our expert Dr Arjun Shrivatsa.
Side-effects of covid vaccine: People are facing the problem of facial paralysis, claims study
Scientists have identified a protein that may cause muscle weakness as you age. But this can happen also due to a sedentary lifestyle or certain health conditions. Read on to know more.
Bell's Palsy is a type of facial paralysis that results in an inability to control the facial muscles on the affected side.
Here are all your questions about Bell's Palsy answered by our expert Dr Arjun Shrivatsa.
