Bell's palsy

Bell's palsy occurs when the
nerve that controls facial muscles on one side of your face becomes
swollen or inflamed. As a result of Bell's palsy, your face feels stiff.
Half your face appears to droop, your smile is one-sided, and your eye
resists closing.

Bell's palsy can affect anyone, but rarely affects people under the age of 15 or over the age of 60.

For most people, Bell's palsy symptoms improve within a few weeks, with
complete recovery in three to six months. About 10 percent will
experience a recurrence of Bell's palsy, sometimes on the other side of
the face. A small number of people continue to have some Bell's palsy
signs and symptoms for life.

Symptoms

Signs and symptoms of Bell's palsy come on suddenly, and may include:

* Rapid onset of mild weakness to total paralysis on one side of
your face — occurring within hours to days — making it difficult to
smile or close your eye on the affected side
* Facial droop and difficulty making facial expressions
* Pain around the jaw or in or behind your ear on the affected side
* Increased sensitivity to sound on the affected side
* Headache
* A decrease in your ability to taste
* Changes in the amount of tears and saliva you produce

In rare cases, Bell's palsy can affect the nerves on both sides of your face.

When to see a doctor
Seek immediate medical help if you experience paralysis, because you may
be having a stroke. Actual Bell's palsy is not caused by a stroke.

See your doctor if you experience facial weakness or drooping, to determine the underlying cause and severity of the illness.

Causes

The most common cause of Bell's palsy appears to be the herpes simplex
virus, which also causes cold sores and genital herpes. Other viruses
that have been linked to Bell's palsy include:

* The virus that causes chickenpox and shingles (herpes zoster)
* The virus that causes mononucleosis (Epstein-Barr)
* Another virus in the same family (cytomegalovirus)

With Bell's palsy, the nerve that controls your facial muscles, which
passes through a narrow corridor of bone on its way to your face,
becomes inflamed and swollen — usually from a viral infection. Besides
facial muscles, the nerve affects tears, saliva, taste and a small bone
in the middle of your ear.


Risk factors

Bell's palsy occurs more often in people who:

* Are pregnant, especially during the third trimester, or who are in the first week after giving birth
* Have diabetes
* Have an upper respiratory infection, such as the flu or a cold

Also, some people who have recurrent attacks of Bell's palsy, which is
rare, have a family history of recurrent attacks. In those cases, there
may be a genetic predisposition to Bell's palsy.

Complications

Although a mild case of Bell's palsy normally disappears within a month,
recovery from a case involving total paralysis varies. Complications
may include:

* Irreversible damage to your facial nerve
* Misdirected regrowth of nerve fibers, resulting in involuntary
contraction of certain muscles when you're trying to move others
(synkinesis) — for example, when you smile, the eye on the affected side
may close
* Partial or complete blindness of the eye that won't close, due to
excessive dryness and scratching of the cornea, the clear protective
covering of the eye

Preparing for your appointment

You'll likely start by seeing your family doctor or a general
practitioner. However, in some cases when you call to set up an
appointment, you may be referred immediately to a neurologist.

It's good to prepare for your appointment. Here's some information to help you get ready.

What you can do

* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along, if possible. Sometimes it
can be difficult to soak up all the information during an appointment.
Someone who accompanies you may remember something that you missed or
forgot.
* Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time
with your doctor. List your questions from most important to least
important. For Bell's palsy, some basic questions to ask your doctor
include:

* What is likely causing my symptoms or condition?
* What other possible causes are there for my symptoms or condition?
* What kinds of tests do I need?
* Is my condition likely temporary or chronic?
* What is the best course of action?
* What are the alternatives to the primary approach that you're suggesting?
* I have these other health conditions. How can I best manage them together?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend?

Don't hesitate to ask questions that occur to you during your appointment.

What to expect from your doctor
Be prepared to answer questions from your doctor, such as:

* When did you begin having symptoms?
* Have your symptoms been continuous or occasional?
* How severe are your symptoms?
* What, if anything, seems to improve your symptoms?
* What, if anything, appears to worsen your symptoms?

What you can do in the meantime
If you have facial pain:

* Take over-the-counter pain relievers. Aspirin, ibuprofen (Advil,
Motrin, others) or acetaminophen (Tylenol, others) may help ease your
pain.
* Apply moist heat. Putting a washcloth soaked in warm water on your face several times a day may help relieve pain.

If you're eye won't close completely, try these tips:

* Use your finger to close your eye repeatedly throughout the day.
* Use lubricant eyedrops every hour.
* Wear eyeglasses during the day to protect your eye.
* Wear an eye patch at night.

Tests and diagnosis

No specific laboratory test can confirm a diagnosis of Bell's palsy.
Your doctor may be able to make a preliminary diagnosis of Bell's palsy
by looking at your face and asking you to move your facial muscles by
closing your eyes, lifting your brow, showing your teeth and frowning,
among other movements.

Other conditions — such as a stroke, infections, Lyme disease and tumors
— also may cause facial muscle weakness, mimicking Bell's palsy. If
your diagnosis is still in question, your doctor may recommend other
tests, including:

* Electromyography (EMG). This test can confirm the presence of
nerve damage and determine its severity. An EMG measures the electrical
activity of a muscle in response to stimulation and the nature and speed
of the conduction of electrical impulses along a nerve.
* Imaging scans. An X-ray, magnetic resonance imaging (MRI) or
computerized tomography (CT) may be needed on occasion to eliminate
other possible sources of pressure on the facial nerve, such as an
infection, tumor or skull fracture.


Treatments and drugs

Most people with Bell's palsy recover fully — with or without treatment.
But your doctor may suggest medications or physical therapy to help
speed your recovery. Surgery is rarely an option for Bell's palsy.

Medications
Study results have been mixed regarding the effectiveness of two types
of drugs commonly used to treat Bell's palsy: corticosteroids and
antiviral drugs.

* Corticosteroids, such as prednisone, are powerful
anti-inflammatory agents. If they can reduce the swelling of the facial
nerve, it will fit more comfortably within the bony corridor that
surrounds it.
* Antiviral drugs, such as acyclovir or valacyclovir, may stop the
progression of the infection if a virus is known to have caused it.

Some clinical studies show benefit from early treatment with
corticosteroids, antivirals or a combination of both types of drugs.
Other studies don't. Evidence of the effectiveness of corticosteroids
appears to be stronger than that for antiviral drugs, and they tend to
be most effective when given within three days of the appearance of
symptoms.

Physical therapy
Paralyzed muscles can shrink and shorten, causing permanent
contractures. A physical therapist can teach you how to massage and
exercise your facial muscles to help prevent this from occurring.

Surgery
One way to relieve the pressure on the facial nerve is to surgically
open the bony passage through which it passes. This decompression
surgery is controversial and rarely recommended. In some cases, however,
plastic surgery may be needed to make your face look and work better.


Lifestyle and home remedies

Home treatment may include:

* Protecting the eye you can't close. Using lubricating eyedrops
during the day and an eye ointment at night will help keep your eye
moist. Wearing glasses or goggles during the day and an eye patch at
night can protect your eye from getting poked or scratched.
* Taking over-the-counter pain relievers. Aspirin, ibuprofen (Advil,
Motrin, others) or acetaminophen (Tylenol, others) may help ease your
pain.
* Applying moist heat. Putting a washcloth soaked in warm water on your face several times a day may help relieve pain.
* Doing your physical therapy exercises. Massaging and exercising
your face according to your physical therapist's advice may help relax
your facial muscles.

Alternative medicine

Although there's little scientific evidence to support the use of
alternative medicine for people with Bell's palsy, some people with the
condition may benefit from the following:

* Relaxation techniques, such as meditation and yoga, may relieve muscle tension and chronic pain.
* Acupuncture, placing thin needles into your skin to relieve pain, may stimulate nerves and muscles, offering some relief.
* Biofeedback training, by teaching you to use your thoughts to
control your body, may help you gain better control over your facial
muscles.
* Vitamin therapy — specifically B-12, B-6 and zinc — may help nerve growth.