Bell’s Palsy

Symptoms usually appear suddenly, worsening over 48 to 72 hours and then gradually improving over two to three weeks with or without treatment. Because the specific cause of Bell’s palsy is unknown—and the seventh cranial nerve can be damaged in many different ways—symptoms can vary from person to person and range from mild weakness to complete paralysis.

The most common symptom of Bell’s palsy is sudden weakness or paralysis in one side of the face. Other signs include drooping of the eyelid or mouth, drooling, and difficulty making facial expressions or closing your eyes. Some people experience pain around the jaw or ear on the affected side, abnormal sensation, a loss or altered sense of taste, and sensitivity to sound.

Typically, a person will have partial or full recovery of the facial muscles within six months. In some cases, muscle weakness can remain longer or, rarely, become permanent.

There is no test for Bell’s palsy. The diagnosis is typically made by assessing symptoms and ruling out other causes. This may include tests to ensure the symptoms are not due to other conditions that can cause facial paralysis, such as brain tumor, stroke, myasthenia gravis, and Lyme disease.

A doctor will do a physical examination for upper and lower facial weakness. They will check how the facial muscles react to making different expressions and trying to close the eyelids. Your doctor may recommend tests to identify an infection or potential underlying conditions that could be contributing to facial weakness or paralysis. They may also look for signs of nerve dysfunction or damage.

Bell’s palsy usually resolves in time. In 85% of cases, people experience improvement within three weeks, and most will fully recover normal facial function. Oral steroids taken within the first 72 hours can be very effective. Steroids help reduce swelling, increase the likelihood of full recovery, and may shorten how long a person has symptoms. There is some suggestion that using antiviral drugs in combination with steroids may also help people with Bell’s palsy recover function, but researchers are still looking for concrete evidence to support this as a method of treatment. Medications like aspirin, acetaminophen, and ibuprofen can reduce pain.

Because Bell’s palsy can affect eye blinking and closure, it’s important to protect the eyes from irritation and dryness. Using eye drops during the day and an ointment and eye patch at night will provide moisture and protection.

Some people find that acupuncture, massage, and physical therapy improve facial function and relieve pain. While in the past surgery has been explored as a way to relieve pressure on the cranial nerve, it is no longer recommended due to the risks of nerve injury or hearing loss.

The National Institute of Neurological Disorders and Stroke (NINDS) is conducting research to better understand the possible causes of nerve damage and ways to diagnose and treat nerve dysfunction. Researchers are currently working to identify the specific mechanisms responsible for nerve regeneration. There are also research studies underway to explore the effect of neuroinflammation on nerve function. Deepening our understanding of how peripheral nerves regenerate will help doctors diagnose and treat conditions like Bell’s palsy.