Banishing Bell’s Palsy
You woke up this morning drooling on the left side of your face. You can’t close your eye on that side of your face. You can’t smile on the same side either. You could have Bell’s palsy.
Bell’s palsy is the sudden partial or complete paralysis of one side of the face. It occurs because the facial nerve, which sends signals to the muscles on that side of the face, stops functioning normally. Palsy is a medical term for muscle weakness. Bell’s comes from Sir Charles Bell, the nineteenth century physician who first described the anatomy and function of the facial nerve.
It is estimated that Bell’s palsy affects 40,000 people each year. Most of the people with Bell’s palsy will recover in a matter of weeks or months. Teenagers, people in their 20s, and people older than 60 seem to be most vulnerable.
Bell’s palsy is somewhat likely to occur during pregnancy especially the last three months. People with diabetes are four to five times more likely to get Bell’s palsy and are especially vulnerable to a reoccurrence. About 8 percent of patients with Bell’s palsy report that a close relative also has had Bell’s palsy, but it is unclear if the condition has a genetic basis.
Symptoms of Bell’s palsy include a sagging eyebrow, an inability to close one eye completely, and a droop in the corner of the mouth. Some people also have decreased tearing and a loss of taste on the same side of the tongue as the palsy.
Another common feature is the ear on the affected side becoming abnormally sensitive to loud noises. The condition can be very upsetting. It distorts the face, making it difficult to eat with your mouth closed, and slurs speech.
According to the National Institute of Neurological Disorders and Stroke, clinical evidence of improvement occurs spontaneously within three weeks in 85 percent of cases, and most people eventually recover normal facial function.
The cause of the initial nerve inflammation has been a big mystery but doctors now believe that in most cases it’s triggered by an infection of the facial nerve by the herpes simplex virus. The herpes simplex virus, the same virus that causes cold sores, remains in the body permanently, after an initial infection, but remains “asleep” causing no trouble most of the time. No one knows why a dormant infection “wakes up” but experts theorize that the immune system may temporarily let down its guard in response to stress or even a minor cold.
Injured nerves outside the brain and the spinal cord have a remarkable ability to heal, which is why most people will recover from Bell’s palsy without medication. Even so, it is standard practice for all patients to get a strong anti-inflammatory corticosteroid like prednisone and an antiviral medication like valacyclovir (Valtrex). Early treatment with corticosteroids improves the chances of a full recovery by about 20 percent. Combined antiviral-corticosteroid has been shown to work better than corticosteroids alone.
Because corticosteroids can have substantial side effects, many doctors are wary of prescribing them to people with diabetes. The medications appear to be the most effective if the patient starts taking them within two to three days after symptoms first appear. And it is controversial whether or not the steroids work. The good news is that the problem usually works out with a majority of patients making a full recovery.
Some measures you can take when you are home include protecting your eye by using lubricating drops, wearing sunglasses during the day and an eye patch at night. Take over-the-counter remedies like ibuprofen (Advil, Motrin IB), aspirin, acetaminophen (Tylenol) if needed. Massaging your facial muscles may help towards recovery.
If problems don’t resolve themselves within a year, nerve grafts and plastic surgery can help restore function and appearance. As symptoms persist, many patients find that facial paralysis becomes a burdensome social problem. The inability to fully move half of the face can make it difficult to register emotions and can cause facial distortions that some people find unsettling.
Surgery is rare. Most patients will wait it out and the condition improves on its own. Please see your physician if you think you might have Bell’s palsy. The earlier the treatment the better the healing.
