Bell’s Palsy

Many of the symptoms of relatively simple and benign medical conditions can mimic those of more serious illnesses.  For example, individuals suffering from a panic attack or gastroesophageal reflux disease may think they are having a heart attack.  

This makes it difficult for us to decide whether to rush to the ER or doctor’s office or to just wait it out.  In most cases, it is better to be safe than sorry and have yourself checked by your physician.  Many diseases are more effectively treated if diagnosed early.

Such is the case with Bell’s palsy.  The condition causes a sudden paralysis on one side of the face, leading the individual to believe he/she is having a stroke.  The condition was first described in 1829 by a Scottish surgeon, Sir Charles Bell; hence the name.  

The facial nerves originate in the brain and travel to each side of the face by exiting the skull below each ear.  The three-branched nerves provide facial sensation, movement of facial muscles (including blinking, closing the eyes, and smiling), and some taste, salivary, and hearing innervations.  In Bell’s palsy, the nerve’s function is disrupted.  

Individuals with Bell’s palsy may experience a facial droop on the affected side; inability to close one eye and raise the eyebrow; numbness or tingling in the face; ear pain; sensitivity to sound; loss of taste; and trouble speaking, eating, and drinking.  The symptoms appear quickly, often overnight, and usually reach a peak in a couple of days.

The exact cause of the condition is not fully known, but it is most common in people ages 15 to 60 years old, pregnant women, and diabetics.  It is often associated with certain viruses such as herpes simplex (HSV), the chicken pox/shingles virus (HVZ), and Epstein-Barr virus (EBV).  It can also occur in the light of other infections such as the common cold, the flu, mono, Lyme disease, and autoimmune disorders.  

Overall, the condition affects only 1 in 5,000 individuals.  Physical, environmental, and emotional stress may play a role in reactivating dormant viruses such as HSV or HVZ.  Metabolic disorders, such as diabetes, may also be contributory.  

There are no specific tests to diagnose Bell’s palsy.  In cases where the history and physical examination of the individual do not rule out a stroke or other more serious condition, an x-ray or imaging test may need to be performed.

In the majority of the cases, Bell’s palsy resolves on its own in one to two months.  Chances of a full recovery are improved by starting steroid medications early to reduce inflammation of the nerve.  Other measures include protecting the eye if the lids are not closing tightly by using eye drops and an eye patch (especially at night); getting plenty of rest and nutrition to allow the body to heal properly; and using heat to any areas of the face that may be swollen or painful.

Most individuals will make a full recovery with no residual effects.  However, a few may have more severe inflammation or damage to the nerve and experience lasting effects.  In many situations improvement facial function can be seen in as early as ten days.        

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.


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