Bell's Palsy

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Introduction

Diagram showing facial nerves

According to a research, it is said that Bell’s palsy is one of the most common nerve damage condition, which affects 2 out of every 10,000 individuals worldwide. Bell’s palsy is “a condition which causes sudden and temporary paralysis of the face”. It is actually a rapid onset of the paralysis on one side of the face. The paralysis happens due to the edema and inflammation of the 7th cranial nerve, called the facial nerve, of which, a key responsibility is to control the movement of the facial muscles. The inflammation of the facial nerve usually occurs by a viral infection. Even though, the situation is scary, but the majority of the patients get full recovery within few weeks.

Signs and symptoms of Bell’s palsy

Bell’s palsy can affect anybody, but you should not be worried about it if you are under the age of 15 or above the age of 60. Disproportionately, the condition attacks the people with diabetes and those suffering from the upper respiratory disease. The degree of paralysis ranges from mild to severe. Usually, when you have the condition, the face becomes very stiff.

Apart from this, 3 more common symptoms occur in facial nerve palsy are:

  • Weakness and complete paralysis on one side of the face. The paralysis may involve some or all the facial muscles of the particular side. It may impact on the patient’s ability to smile or blink the eyes. The symptoms may remain for a few hours or several days. Heat therapy to the affected side may help reduce the pain.
  • The pain can radiate to the jaw area, around the ear on the side of the face, and also, can cause a headache. The patients may also experience extreme sensitivity in the ear when subjected to various sounds, which may lead to ear pain, tearing of the eyes, drooping eyelids, drooling of the saliva, and headache. The patients find difficulty in eating and drinking.
  • Most of the patients experience some changes in the secretary glands, like changes in the production of the tear, saliva, etc., which are related to lack of functional activity of the affected nerve linked in these mechanisms.

    • What are the causes of Bell’s palsy?

    The exact cause of peripheral facial palsy or damage of the facial nerve is not yet clearly understood. But, it is believed that the condition is mostly caused by a viral infection, known as herpes simplex Virus-1 (HSV-1). However, it can also be triggered by the following factors:

  • Upper airway infection
  • Diabetes
  • Chronic ear infection
  • High blood pressure
  • Lyme disease
  • Tumors
  • Pregnancy (during the first trimester).
  • Autoimmune disease

    • These are some of the factors but not limited to that can cause the Bell’s palsy.

    How to do a proper diagnosis of Bell's palsy?

    The physician will check other possible conditions first, which may cause the disease, like a tumor, Lyme disease, stroke, or any other underlying condition. Then, he will examine the muscles of the face, and also check if any other nerve is affected. Change in the facial structure is a strong sign of an existing tumor. A particular type of rash may be an evidence of Lyme disease. So, your doctor will rule out the underlying cause, by doing a proper examination. If he/she does not find any other underlying cause, then it is diagnosed as Bell’s palsy. But, if the doctor is still not sure about the diagnosis, he/she may refer the patient to an otolaryngologist (ear, nose and throat specialist). The otolaryngologist will examine the patient, and may advise going for the following tests:

    EMG (Electromyography):

    In EMG, electrodes are placed on the patient's face. A machine measures the electrical activity of the nerves and the face, in response to the stimulation produced by the electrodes. This test can help determine the extent of the nerve damage, as well as its location.

    CT scans or X-rays, MRI:

    It is used to diagnose the underlying conditions, like a bacterial infection, skull fracture, or a tumor.

    How to cure Bell’s palsy?

    Some patients with Bell’s palsy have permanent weakness, or other have defects on the affected side. Most of the patients recover within 1-2 months completely, even without any treatment. But it is only possible if the patient can still move the facial muscles. However, some of the treatments of Bell’s palsy are as follows:

    Conservative management:

    Medicines:

    Corticosteroids: Powerful anti-inflammatory agents such as prednisone to reduce the facial nerve swelling. These drugs may be effective if started within several days of when your symptoms started.

    Eye protection:

    Bell's palsy usually affects the eyes and can impact on the ability to blink the eyelid. Normally, it is important to keep the eyes moist and free of debris, especially at night. Lubricating eye drops and eye patches can be effective for it.

    Massage:

    A facial massage can help prevent the permanent problems associated with paralyzed muscles. Usually, the patients with Bell's palsy are always in need of relaxation, because the condition causes a lot of mental stress, which can worsen the problem.

    Surgery:

    Actually, the surgery is preferred to decompress and realign the facial nerve. But there is no guarantee that it will work well. The risk of side effects is also higher after the surgery. In some cases, plastic surgery is recommended to reduce the deformities, and to correct the damage.

    Physiotherapy:

    In some cases, physiotherapy can help people who suffer from neurological disorders, like Bell's palsy. Physiotherapy treatment can help progress the recovery, and correct the deformities. Some of the effective physiotherapy treatments are:

    Electrical Stimulation:

    Electrical stimulation helps you in strengthening the weak muscles.

    Manual Massage:

    This is one of the oldest methods of physiotherapy treatment. It is also known to have the following beneficial effects:

  • It provides muscular relaxation
  • It decreases the chances of muscle atrophy
  • It increases blood supply to the paralyzed part.

    • Bell’s palsy facial exercises:

    Following exercises are recommended to improve the strength of the facial muscles (see the pic below)

    Diagram showing facial exercises for Bell's palsy

    How can you take care of yourself by lifestyle and home activities?

  • Keep the face warm
  • Apply moist heat to the paralyzed area to help reduce the pain
  • Wear a scarf or jacket with a hood
  • Eat on the normal side of your mouth
  • Try drinking with a straw
  • Use protective eyewear

    • It is quite frustrating for any individual to suffer from a medical condition like Bell’s palsy, because, you cannot respond with your facial expression. The patients, who have the condition, should take help through counseling, and also should be in contact with the people who experienced or experiencing the same thing, through various forums and networks. It will help them reduce the mental frustration, and also, come out of the feeling of embarrassment. Remember, you are not alone, who is having Bell’s palsy!