Bell's Palsy: What Is It, Symptoms, Causes & Treatment

Updated in April 2022

Bell’s Palsy is a condition in which the facial nerve becomes inflamed leading to a loss of control of the muscles on one side of the face. People often experience a crooked mouth, a tingling sensation, and difficulty making facial expressions.

Most of the time, the inflammation is temporary, and it happens after a viral infection, such as herpes, mononucleosis or, mumps. The condition generally takes a few weeks up to around six months to disappear, but it can also become a permanent condition, if the facial nerve canal is damaged.

If you have facial paralysis, proceed immediately to the emergency room, as this symptom may also be a sign of a serious problem, like a stroke. Early identifcation and inverventions are essential.

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Main symptoms

The main symptoms include:

  • Paralysis on one side of the face;
  • Crooked mouth and drooping eye;
  • Difficulty making facial expressions, eating or drinking;
  • Slight pain or tingling sensation on the affected side;
  • Dry eyes and mouth;
  • Headache;
  • Difficulty holding saliva.

These symptoms generally appear quickly and affect one side of the face, however, there are rare cases in which there is nerve inflammation on both sides of the face, leading to symptoms on both sides of the face.

Bell’s Palsy symptoms are similar to symptoms that appear as a result of serious conditions, such as a stroke or a brain tumor, therefore it is to be assessed immediately.

How to confirm a diagnosis 

A diagnosis is normally reached through assessment of the facial muscles and evaluation of related symptoms. The doctor may order other tests, such as a CT, MRI, and blood tests. These tests will help the doctor to rule out other possible conditions to determine whether you have Bell’s Palsy.

What can cause Bell’s Palsy?

It is not known what causes the inflammation of the facial nerve and the existence of Bell’s Palsy, however, it is common for this condition to happen after viral infections, such as:

  • Herpes Simplex or Herpes Zoster
  • HIV
  • Mononucleosis
  • Lyme Disease

Additionally, Bell’s Palsy is more common in pregnant women, diabetics, patients with lung infections, or when there is a family history of paralysis.

Treatment options

Treatment for Bell’s Palsy can be completed with a combination of medication, physiotherapy and speech therapy. Most people recover completely within one month of treatment.

The different types of treatment include:

1. Medication

Medication for Bell's Palsy should be prescribed by a neurologist and usually consists of corticosteroids (e.g. prednisone or prednisolone) and antiviral medication (e.g. aciclovir or valaciclovir). These medications can be started within the first three days of symptoms. 

Facial muscle contraction associated with Bell's Palsy may cause pain. In these cases, the doctor may prescribe analgesics such as acetylsalicylic acid or acetaminophen to help relieve pain.

If you are unable to close one eye due to the facial paralysis, you can apply eye drops to the affected eye before falling asleep. This will protect the eye from extreme dryness. You can also apply eye drops and wear sunglasses to protect your affected eye from the sun and win.

2. Physiotherapy

Exercises completed at physiotherapy are aimed at strengthening the facial muscles and improve circulation to the affected nerve. The following are examples of physiotherapy exercises used in Bell's Palsy treatment:

  1. Opening and closing eyes forcefully
  2. Raising eyebrows
  3. Frowning to bring eyebrows together
  4. Smiling or grinning
  5. Clenching teeth together
  6. Pouting;
  7. Placing a pen in the mouth and trying to draw something with it
  8. Puckering lips
  9. Opening the mouth as wide as possible
  10. Wrinkling the nose
  11. Blowing bubbles
  12. Filling a balloon with air
  13. Making silly faces
  14. Opening nostrils

These exercises can also be done at home to treat the symptoms quickly, but they should be first supervised by a physiotherapist.

During the exercises, the physiotherapist may use an ice cube rolled up in a napkin to slide over the paralyzed area to stimulate the muscle contraction. The therapist may also aid and help the direction of the movement by placing two or three fingers on the face, then taking them away, so you can hold the contraction..

3. Acupuncture

Some studies on acupuncture for the treatment of Bell's Palsy show that this traditional Chinese technique may improve functioning and reduce the rigidity of the facial nerve. Acupuncture aims to stimulate nerve fibers in the skin and in the facial muscles. 

4. Surgery

In some situations, the doctor may recommend surgery, especially if there is a lot of nerve compression. Nerve compression is confirmed following an electromyography (EMG). 

5. Speech therapy

Speech therapy sessions can also be a part of the treatment, as therapists can also can help with facial movements and expression. Most times, speech therapy will also stimulate your speaking, chewing, and swallowing functions. This type of therapy should be guided by a trained professional and the number of sessions per week, and the duration will be set by the speech therapist together with the doctor.

How long does recovery take?

Complete recovery generally takes approximately three to four months, and as soon as physiotherapy starts you will see progress straight away. Only 15% of people who have peripheral facial paralysis do not recover completely and may need to use Botox or undergo surgery a few months later.