Bells Palsy

BELLS PALSY - WHAT IS IT?

Bell's palsy is an acquired weakness of one side of the face, due to an injury to the facial nerve. The symptoms on the affected side typically include inability to close the eye, to smile, wrinkle the forehead and whistle. Speech may be mildly slurred. Tearing occurs because the eye does not close completely. Taste sensation may be diminished on the front half of the tongue. Sounds may appear louder on the affected side (hyperacusis) -- this may be caused by paralysis of the stapedius muscle but also occurs independantly. Papillitis may be seen of the fungiform papillae of the affected side. Bell's palsy usually develops over hours to days. The peak involvement usually happens within several days. Mild pain behind the ear is common at onset, as is a subjective sensation of "numbness" of the affected side. Usually it is first noticed when a persons observes it in a mirror, or on eating because food tends to collect between the cheek and gums. *

HOW COMMON IS BELLS PALSY?

About 25/100,000 persons per year develop Bell's palsy. The incidence increases slightly with age. There are only minor differences in rates between the sexes and among persons of different race. There is a slightly higher incidence in the winter. *

ells palsy has numerous potential causes. It is presently thought that most cases arise from herpes simplex virus infections (the same one that gives you cold sores in your mouth as well as other variants). However, there are a wide variety of other possibilities including diabetes, sarcoid, HIV infection, and various cancers. *

Individuals at increased risk for idiopathic lower motor facial palsy (i.e. facial weakness due to injury to the nerve or facial nerve nucleus in the brainstem) include pregnant women, diabetics, those who have had recent episodes of influenza or respiratory infection, and those with family history of the disease. *

Other causes of facial palsy include trauma, CNS disorders, neoplasms and infectious disease (e.g. Lyme disease). Facial palsy is rarely caused by middle ear infection, where it is felt that facial nerve dehiscence may expose the nerve and make it more vulnerable. In acute cases, parenteral antibiotics and myringotomy is generally the treatment. Surgical treatment may be undertaken in patients with epidural abcess, cholesteatoma or mastoiditis. *

All patients with Bell's palsy need to take precautions against drying of the eye on the side of facial weakness. This will generally include use of artificial tears during the day, and use of "lacrilube" jelly at night. Eye patches are often counterproductive because the eyelid easily gets dislodged from the patch, allowing the eye to brush against the patch causing discomfort and potential damage. A moisture chamber can be used as an alternative to frequent use of eye drops during the day. The moisture chamber keeps the cornea from drying. In persons who have persistent redness or visual obscuration, a ophthalmologist's help must be enlisted. In some instances, the lid must be sewed shut until facial movement improves. Gold weights can also be placed in the lid to keep it closed. *

Prednisone treatment is thought to speed recovery and reduce the frequency of a bad result. Prednisone must be given within the first week of facial weakness, in order to be effective. Usually a dose of about 60 mg is given per day in a single morning dose. This dose is usually continued for about a week, and then tapered off to nothing at about 10 days. *

Surgery is not needed in most cases of idiopathic Bell's palsy, as 90% of patients recover spontaneously. In cases where there has been trauma, facial nerve decompression may be justified. This area is controversial -- the surgical literature is more optomistic about the benefits of surgery than the medical literature. *

Physical therapy is not generally thought to be helpful although it probably doesn't hurt. In persons with severe residual impairments at least 1 year after onset, several surgical procedures are available to improve cosmetic appearance. *

About 7% of patients have recurrent Bells palsy. The mean recurrence interval is 10 years. Recurrent Bells tends to cluster in families as well as diabetics. *

*All information obtained from: www.bellspalsy.org.uk/main.htm

Where to now?

Research
Diary of a woman with Bells Palsy
Meet Michele