Dear Doctor Column, May 30, 2005

Inflamed Nerve Cause Bell's Palsy, Prognosis Good

Question:

My 18-year-old son was diagnosed with Bell's Palsy 7 weeks ago. The physicians in the emergency room placed him on a short course of steroids, which he completed. Within the first couple of weeks, he also was seen by a neurologist who confirmed the diagnosis. He has improved very little, but he can now move his right eyelid, and he no longer has to drink from a straw. How long should I wait before seeking other treatment? I can't believe in this day and age that we have to take a wait-and-see attitude.

Answer:

Bell's palsy results from damage or trauma to 1 of the 2 facial nerves that control facial muscles. The swollen, inflamed, or compressed facial nerve causes facial muscle weakness or paralysis.

Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing and facial expression, such as smiling and frowning. Because the facial nerve also controls the production of saliva and tears, their production is decreased, and taste may be impaired. Other symptoms may include pain or discomfort around the jaw and behind the ear, ringing in one or both ears, headache, hypersensitivity to sound on the affected side, impaired speech, dizziness, and difficulty eating or drinking.

Approximately 40,000 Americans are afflicted with Bell's palsy each year. It affects men and women equally and can occur at any age, although it is less common before age 15 or after age 60.

Risk Factors

Scientists believe a viral infection, such as viral meningitis, mumps, or the common cold sore virus (herpes simplex), can cause the inflammation and swelling of the facial nerve that results in Bell's palsy. The disorder also has been associated with bacterial infections such as Lyme disease or tuberculosis, headaches, chronic middle ear infection, high blood pressure, tumor pressing on the nerve, trauma such as skull fracture or facial injury, or neurological disorders such as Guillain-Barré syndrome, multiple sclerosis, and myasthenia gravis. Stress, pregnancy, and diabetes also are risk factors. In fact, people with diabetes are more than 4 times as likely to develop the disorder, compared with the general population.

There is no cure or standard treatment for Bell's palsy. The most important factor in treatment is to eliminate any source of nerve damage.

Outlook Good

Bell's palsy affects individuals differently. Some cases are mild and do not require treatment, as the symptoms usually subside on their own. For others, treatment includes medications and other therapeutic options.

Recent studies have shown steroids are an effective treatment for Bell's palsy. An antiviral drug, such as acyclovir (used to fight herpes viral infections), combined with an anti-inflammatory drug, such as the steroid prednisone (used to reduce inflammation and swelling), may improve muscle function by limiting or reducing damage to the nerve. Analgesics, such as aspirin, acetaminophen, or ibuprofen can relieve pain.

Another important factor is eye protection. Bell's palsy can interrupt the eyelid's natural blinking ability, leaving the eye exposed to irritation and drying. Therefore, keeping the eye moist and protecting it from debris and injury, especially at night, is important. Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches, also are effective.

Physical therapy to stimulate the facial nerve and help maintain muscle tone may be beneficial to some. Facial massage and exercises help prevent permanent contractures (shrinkage or shortening) of the paralyzed muscles before recovery takes place. Moist heat applied to the affected side of the face may reduce pain. Other therapies of variable benefit include relaxation techniques, acupuncture, electrical stimulation, and biofeedback training.

Decompression surgery for Bell's palsy to relieve pressure on the nerve is controversial and seldom recommended. On rare occasions, cosmetic or reconstructive surgery is needed to reduce deformities and correct damage such as a crooked smile or an eyelid that will not fully close.

The prognosis for individuals with Bell's palsy is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of symptoms and most completely recover, returning to normal function within 3 to 6 months. For some, however, symptoms last longer. In a few cases, the symptoms never completely disappear. In rare cases, the disorder recurs, either on the same or the opposite side of the face.

For more information, go to the American Academy of Otolaryngology-Head and Neck Surgery Web site, the National Institute of Neurological Disorders and Stroke Web site, or the Web site of the National Organization for Rare Disorders.