Bell's Palsy

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What is Bell’s palsy?

Bell’s palsy is a term used to describe a sudden onset facial paralysis, unilateral or more rarely a bilateral. It is the most common cause of acute facial paralysis

Bell’s palsy accounts for approximately 60 per cent of all cases of sudden onset facial paralysis. It affects from 20 to 40 per 100,000 people per year.


What causes Bell’s palsy?

Whilst the exact cause of Bell’s palsy has not been established, viral aetiology is strongly suspected (Herpes Simplex Virus (HSV)). It has also been linked to other viruses, and associated with a depleted immune system and stress.


What are the symptoms of Bell’s palsy?

Sudden onset of facial weakness or paralysis.  Patients may report ear pain or a period of flu-like illness prior to onset.  In seven out of ten cases, it will slowly disappear over a period of weeks or months.

Patients may experience impaired or altered sense of taste, sensitivity to loud noises (hyperacusis,  drying of the eye on the affected side, where the eye cannot be closed properly, difficulty with eating, due to loss of control of the lips and mouth on one side; difficulty with speaking clearly.


What is the initial treatment for Bell’s palsy?

The mainstay of initial treatment to help reduce inflammation on the facial nerve is steroids.  Steroids need to be given within within 72 hours of the symptoms appearing in order to have any beneficial effects.

Aciclovir is the antiviral drug which is often prescribed for the initial treatment.

The psychosocial aspects of living with facial palsy should not be underestimated.  Advice and support can be found at the Facial Palsy UK charity website.

Ensure also that the patient understands the importance of eye care.


What is the management for unresolved facial weakness in confirmed cases of Bell’s palsy?

Once the diagnosis of Bell’s palsy is confirmed then referral to a Facial Palsy Specialist is the treatment of choice, and may include:

- Therapy; to maximise recovery

- Massage; stretches for hypertonic muscles; relaxation and neuromuscular re-education.

- Botulinum Toxin; for ipsilateral synkinesis (a secondary symptom of unresolved Bell’s palsy whereby muscles start to move involuntarily, e.g. the eye closes during smiling or eating/drinking.)

- Reconstructive surgery; (facial reanimation) to assist with eye closure, or to help recreate resting or dynamic symmetry.

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