Bell’s palsy is a sudden and unexplained episode of facial paralysis or weakness that typically affects one side of the face. It is also known as idiopathic facial palsy.
Bell’s palsy is the most common cause of facial paralysis. It generally affects one side of the face, but in rare cases it can affect both sides. Symptoms come from damage, inflammation, or other issues with the seventh cranial nerve—a nerve that sends messages to different parts of the face and head. Usually Bell’s palsy is temporary, resolves with time, and doesn’t cause long-term complications.
Number of people affected in the U.S. each year
15 to 45 years old
Age range with the highest incidence of Bell’s palsy
Percentage of cases that show improvement within three weeks
What Causes Bell’s Palsy?
While we know that the symptoms of facial paralysis or weakness are a result of dysfunction of the seventh cranial nerve, the exact cause of Bell’s palsy is unknown. Researchers think the source of this dysfunction may be due to inflammation of the seventh cranial nerve. This inflammation may be related to a viral infection or lowered immunity due to stress, lack of sleep, or illness. Swelling puts pressure on the nerve and restricts blood and oxygen from moving to the nerve cells.
While Bell’s palsy can affect people of any age, it has the highest incidence among people who are 15 to 45 years old. It affects men and women equally. Risk factors can include pregnancy (especially the third trimester and first week after giving birth), preeclampsia, obesity, high blood pressure, diabetes, autoimmune diseases, and upper respiratory infections like a cold or influenza.
Recurrent episodes of Bell’s palsy are rare. When they do occur, it’s typically in people with a family history of the condition, which means there may be a genetic factor.
Bell’s Palsy Signs and Symptoms
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.
Bell’s Palsy Diagnosis
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 Treatment Options
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.
Bell’s Palsy Research Efforts
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.
Orlena was driving with her young daughter in the car when she suffered a stroke because of a rare brain vessel disorder called Moyamoya. After two brain surgeries and six months unable to care for her daughter, Orlena began to reclaim her independence and became a Moyamoya advocate.
At 15 years old, Zoe has been navigating her Tourette syndrome diagnosis for eight years. “I had to figure out at a young age how my emotions affect my tics, from good to awful ways. It has been frustrating to figure out on my own and learn to deal with. This was the first moment in my life where my parents couldn’t fix something for me.”
Sasha was diagnosed with epilepsy after sustaining a soccer-related brain injury in high school. Since then, Sasha has worked to find both a treatment that controlled her seizures and a career that fulfilled her desire to care for others. “Life isn’t meant to be lived taking multiple medications and having seizures you can’t control.”
Before frontotemporal lobe dementia, sometimes called Pick’s disease, Ken Keene Sr. was a respected community member and a handyman who could fix anything. For his oldest son and namesake Ken Keene Jr., there was nothing his father couldn’t do: “To my family, he was just that super dad. Then all of a sudden he’s reaching out for help.”
It started with a twinge. After a simple surgery and some physical therapy, Morgan wasn’t getting better. It took two more surgeries before she was diagnosed with Complex Regional Pain Syndrome (CRPS) type II.
In 2018, Kelly was diagnosed with glioblastoma after an MRI confirmed that a golf-ball-sized tumor above her right ear was affecting the left side of her body. After surgery to remove the tumor, Kelly was able to get through her darkest days with a healthy dose of humor. Now she is an advocate for other patients living with strokes and brain tumors.
When her father was diagnosed with vascular dementia in 2005, Nancy quickly shifted into the role of his caregiver. Nancy and her sisters drew from their individual strengths to provide their father with medical assistance and emotional support until his passing in 2012. At that time, he was diagnosed again with Lewy body dementia. “No matter what your financial situation, there’s probably going to be help out there… Just don’t do it alone, because burning yourself out is not going to help anybody.”
Maureen worked as a high school English teacher until she started experiencing a confusing array of symptoms that affected her ability to work, along with her relationships with family and friends. After visiting numerous specialists for years, Maureen received a delayed diagnosis of Lewy body dementia. Now Maureen wants to raise awareness about what life is like with living with this disease. “I felt that I just wanted to offer something to this community that I hadn’t been able to find really.”
For the first 32 years of his life, Joey experienced seizures from epilepsy. For several years, Joey worked hard in his career as a pipe welder and in construction until his seizures started happening more frequently and intensely. Brain surgery became Joey’s only viable option for treatment. Doctors were unsure if Joey would be able to survive after finding more brain damage than expected, but he surprised everyone by thriving during his post-surgery recovery.
At age 40, Ben was perfectly healthy and active until he started noticing the early symptoms of a neurological condition that weakened his physical movements. After a 2-year search for his diagnosis of X-linked adrenoleukodystrophy, he began his journey as an advocate for others living with rare diseases. Last year, Ben joined the board of the American Brain Foundation to further his impact.
In 2002, while her young daughter battled a fatal diagnosis of pons glioma, Michele experienced a life-threatening brain hemorrhage when a brain malformation she likely had since birth ruptured. She experienced drastic changes in the way her brain functioned, especially in regard to memory and spatial awareness. Today, Michele is still learning to adjust. “When someone’s brain is not functioning correctly it impacts everything in their life. It impacts how they think, how they feel about themselves, it’s a very hopeless space to be in as a person.”
Matt is a husband, father, and professional photographer. Over the past 11 years, he has had surgeries and radiation to remove five benign brain tumors. Following the third surgery, he began to experience more struggles in his daily life. “I think the biggest loss is my relationship to my family. They saw me as the dad and strong. Now they can’t count on me as much. It’s important to support people with brain disease ‘cause it can happen to anybody.’”
When she was in her early 30’s, Mary Jo’s relationship with her parents was forever altered by brain disease. Her father suffered a subdural hematoma, was diagnosed with diabetic neuropathy, and experienced a stroke while her mother was diagnosed with Alzheimer’s and dementia. “They’re a responsibility that I have to take care of as they have taken care of me.”
Tom suffers from dystonia, a painful neurological movement disorder with no known cure. When he first started experiencing strange pains and cramps in his neck muscles, he saw chiropractors and physical therapists—but when this didn’t help, Tom started down a long and painful road to an eventual diagnosis. Before his diagnosis at 30 years old, Tom was an athlete and an entrepreneur, but as his symptoms worsened, even performing everyday tasks became a challenge. Before long, the pain became debilitating. Over time, Tom learned to accept his new limitations and focus on his physical and mental health.