Facial paralysis

Dear Alice,

Do you know if there's any information on what it might be that spurs on Bell's palsy?

Dear Reader,

That’s a good question; unfortunately, there’s no straightforward answer. Bell's palsy, or facial palsy, is a temporary type of facial paralysis that results from damage or trauma to the facial nerve. Bell’s palsy occurs in men and women equally, affecting approximately 40,000 Americans each year. When a person has Bell’s palsy, damage to the facial nerve from inflammation, swelling, or compression causes an interruption in the messages the brain sends to facial muscles. This may result in weakness or paralysis on the side of the face. What causes or spurs the damage isn’t clear — but there's ongoing research to find answers.

Many researchers believe that the disorder may be related to the herpes simplex virus. In addition, Lyme disease, flu-like illnesses, mumps, rubella, mononucleosis, ear infections, respiratory illnesses, high blood pressure, and diabetes have all been associated with Bell’s palsy. The disorder disproportionately affects people who have diabetes or upper respiratory infections. To further clarify Bell’s palsy is not caused by a stroke — a stroke can cause facial paralysis, but it isn’t linked to Bell’s palsy.

More is known about the symptoms associated with Bell’s palsy than the cause. They may range in severity and often appear suddenly, peaking within 48 hours. Bell’s palsy symptoms vary from person to person and may include: 

  • Rapid onset of mild weakness to total paralysis on one side of the face — occurring within hours to days
  • Facial droop and difficulty making facial expressions
  • Drooling
  • Pain around the jaw and ear
  • Increased sensitivity to sound on the affected side
  • Headache
  • A decrease in ability to taste
  • Changes in the amount of tears and saliva produced

List adapted from Mayo Clinic.

The symptoms may mimic other conditions — so, if a person experiences any unusual facial weakness or paralysis, it’s wise to consult a health care provider to investigate further.  

The good news is that most people recover fully from Bell’s palsy, often with no treatment; however, it can sometimes take weeks or months for symptoms to go away completely. In severe cases, treatments may include medications and therapeutic options such as anti-inflammatory drugs, painkillers, physical therapy, and facial muscle exercises. Corticosteroids, such as prednisone, are an example of an anti-inflammatory drug that’s used to reduce inflammation and swelling of the facial nerve. Antiviral drugs may also be used to treat Bell’s palsy, though their effectiveness for the condition is still up for debate. While decompression surgery used to be a possible treatment, it isn't recommended anymore. Another treatment consideration is eye care and protection (such as wearing sunglasses or using a finger to help you blink), since Bell’s palsy may interrupt the eyelid’s natural blinking ability and lead to dryness or irritation.

Researchers are working to better understand what causes Bell’s palsy. As part of this effort, the National Institute of Neurological Disorders and Stroke (NINDS)  is conducting research to learn more about the causes of nerve damage as well as conditions that injure or damage nerves. There's also research being done to develop methods to repair damaged nerve cells and find ways to prevent nerve damage and injuries from occurring. So, it looks like you’re not the only one who’s curious about this condition. Stay tuned for more information as it becomes available!

Last updated Feb 05, 2016
Originally published Jan 17, 1997