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Bell’s palsy

Bell's palsy is a condition that causes paralysis on one side of your face. The symptoms usually come on suddenly but have no obvious cause. Most people make a full recovery.

Bell's palsy is caused by damage to your facial nerve, causing weakness to the muscles on one side of your face. Bell's palsy is the most common cause of facial paralysis worldwide.

In the UK, about one in 5,000 people develop Bell's palsy every year. It can affect people of all ages but is most common between the ages of 15 and 60. Men and women are equally affected.

Bell's palsy is named after Sir Charles Bell, a nineteenth-century doctor who first described the condition and linked it to a problem with the facial nerve.

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Details

  • Symptoms Symptoms of Bell's palsy

    The symptoms of Bell's palsy usually come on suddenly, often within a few hours or overnight, and are at their worst within two days.

    The main symptom is that one side of your face becomes weak or paralysed. Symptoms can range from mild to complete paralysis. You may find that on the affected side of your face:

    • your eye is difficult to close and you find it hard to blink
    • your eye is very watery or very dry
    • your eyebrow sags
    • the corner of your mouth droops, causing saliva and drinks to dribble from your mouth

    Other symptoms may include the following.

    • Pain or discomfort around your jaw and behind your ear. It may feel like you have just had treatment at the dentist.
    • A ringing noise in one or both of your ears.
    • Being unable to taste at the front of your tongue.
    • Difficulties with speaking and eating.

    When you smile, you may notice that the affected side of your face appears expressionless, because your muscles are unable to move.

    These symptoms may be caused by problems other than Bell's palsy, but if you have them, see your GP immediately for advice. For more information on conditions that can cause similar problems to Bell’s palsy, see our FAQ.

  • Diagnosis Diagnosis of Bell's palsy

    Your GP will ask about your symptoms and examine you. It's usually possible to diagnose Bell's palsy by looking at how your face is affected on one side.

    Your GP may refer you to a neurologist (a doctor who specialises in identifying and treating conditions that affect your nervous system, including your brain) or an ear, nose and throat (ENT) specialist. You may also need to see an ophthalmologist (a doctor who specialises in identifying and treating eye conditions) to treat any complications in your eye.

  • Treatment Treatment of Bell's palsy

    For most people, Bell's palsy gets better by itself without any treatment. Symptoms usually start to improve within three weeks. Almost all people make a complete recovery within six months. If your condition is mild, your GP will usually recommend you take some self-help measures to help you recover. You may, however, need medicines or surgery if your condition is longer term or more severe.

    Self-help

    If you have Bell's palsy, you may find it difficult to blink and close your eyelid. This means that the surface of your eye could be at risk of drying out. You can keep your eye moist by using:

    • lubricating eye drops, such as artificial tears, eye ointments or eye gels to stop your cornea from drying out
    • a transparent eye shield to protect your eye during the day
    • tape to keep your eye closed before you go to sleep

    Always read the patient information leaflet that comes with these products and if you have any questions, ask your pharmacist for advice.

    If your eye becomes red or painful, or your vision becomes blurred, then it’s important to see your doctor urgently as there may be a scratch on the surface of your eye which could become infected.

    You should also stay away from playing ball sports that may injure your affected eye.

    Medicines

    Your GP may prescribe you a steroid, such as prednisolone, to reduce the inflammation in your facial nerve. If you have this treatment within three days of your symptoms starting, you're more likely to recover. You will usually need to take the tablets for 10 days.

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    Complementary therapies

    Research has suggested that acupuncture and physical therapies, such as facial exercises and massage, may be beneficial for Bell's palsy. However, more research is needed to confirm whether these treatments are effective.

    Surgery

    If your symptoms don't go away after six to nine months, by themselves or with medical treatment, cosmetic or reconstructive surgery may be an option. For example, your GP may refer you for treatment if your eyelid doesn't fully close or your smile is crooked. Speak to your GP for more advice.

  • Bupa On Demand

    You can receive private treatment, scans and consultations on a pay-as-you go basis with Bupa On Demand. Find out more today.

  • Causes Causes of Bell's palsy

    The symptoms of Bell's palsy occur when the nerve that controls the muscles in your face becomes inflamed or compressed.

    The exact cause of Bell’s palsy isn’t known, but the herpes simplex virus, which causes cold sores, may be associated with the condition. If the virus causes infection near your facial nerve, it can become swollen and inflamed.

    You may be more likely to develop Bell's palsy if you have diabetes or are pregnant, although the reasons for this aren’t known.

  • Complications Complications of Bell's palsy

    About three-quarters of people with Bell's palsy recover completely. However, if your symptoms don't improve within three to six months, you may find that:

    • your eye dries out and forms an ulcer – this can become infected and may leave a scar on your cornea (the clear surface of your eye)
    • the muscles in your face continue to feel tight and weak
    • you have spontaneous twitches or spasms in your face muscles (also known as synkinesis)
    • you appear to cry when you’re eating because saliva is misdirected from your saliva glands to your tear gland (sometimes called crocodile tears)

    If you have Bell’s palsy after the age of 60, you may not recover as quickly or as fully.

  • FAQs FAQs

    Is there anything I can do to improve my chances of recovering from Bell's palsy?

    Answer

    Taking a short course of prednisolone within three days of the first symptoms of Bell's palsy appearing has been shown to increase your chances of a complete recovery.

    There is also some evidence that physiotherapy can improve symptoms, but more research is needed to confirm these findings.

    Explanation

    Bell's palsy affects people in different ways and there is no way to predict how long you will have symptoms of the condition.

    Research has shown that taking a short course of a steroid called prednisolone improves the chances that you will make a complete recovery from Bell's palsy. However, this medicine may not be suitable, or have the same effects for everyone. Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    Physiotherapy treatments involving facial exercises have been shown to improve symptoms, but more research is needed before we can say this for certain.

    Are there any other conditions that can cause similar symptoms to Bell's palsy?

    Answer

    Yes, there are a number of conditions that can cause similar symptoms to Bell's palsy, some of which need immediate treatment, so it’s important to see your GP if you have any of the symptoms of Bell’s palsy.

    Explanation

    The following conditions can cause very similar symptoms to Bell's palsy.

    • Parotid tumour. This may be a benign (not cancerous) or malignant (cancerous) lump in your saliva gland.
    • Stroke.
    • Lyme disease. This is an infectious disease caused by the Borrelia burgdorferi bacterium.
    • Middle ear infection. This is medically known as otitis media.
    • Ramsay Hunt syndrome. This is an outbreak of varicella zoster virus (which causes chicken pox) in your facial nerve.

    These conditions can cause weakness or paralysis in one side of your face, but they usually have additional features that distinguish them from Bell's palsy. If you think you may be affected, see your GP immediately for further information and advice.

     

    Are there any side-effects of the steroids used to treat Bell's palsy?

    Answer

    Prednisolone, the steroid that is usually recommended for Bell's palsy, can cause a number of side-effects, but these usually subside a few days after you start taking it.

    Explanation

    Everyone reacts to medicines in different ways. You may have no side-effects, but if you do, they may be mild or more severe. The possible side-effects of prednisolone may include changes to your mood, feeling sick, indigestion, abdominal (tummy) pain and an increased appetite. If you have diabetes, prednisolone may make your symptoms worse.

    Most people with Bell's palsy are advised to take a 10-day course of prednisolone. Any side-effects you have from this medication will usually improve within a few days.

    There may be other side-effects of prednisolone that aren't listed here. If you think you may be affected, it's important to talk to your GP before you stop treatment. Read the patient information leaflet that comes with your medicine for more information.

    Is it true that acupuncture can help people with Bell's palsy?

    Answer

    There isn't enough evidence to say whether or not acupuncture is helpful for Bell's palsy. If you're thinking about trying acupuncture, talk to your GP.

    Explanation

    Acupuncture is a complementary medicine that has been used for thousands of years in China. It involves inserting fine needles into specific points on the skin to help restore the balance of an energy known as Qi in the body. It’s thought that acupuncture can help the symptoms of Bell’s palsy by increasing blood circulation and promoting nerve healing.

    Some clinical trials have found that acupuncture improves recovery from Bell's palsy, whereas others haven't found it to be effective at all. When all of the evidence was looked at together, researchers concluded that there wasn't enough information to say whether acupuncture provided benefits or not. However, none of the studies showed acupuncture to be harmful to people with Bell's palsy. If you're considering having acupuncture for Bell's palsy, ask advice from your GP first.

  • Resources Resources

    Further information

    Sources

    • Bell's palsy. BMJ Best Practice. www.bestpractice.bmj.com, published 28 July 2011
    • Chantal S, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010:546
    • Bell's palsy fact sheet. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov, published 26 August 2011
    • Bell palsy. eMedicine. www.emedicine.medscape.com, published 11 April 2012
    • Bell's palsy. Prodigy. www.prodigy.clarity.co.uk, published September 2008
    • Sullivan FM, Swan IRC, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell’s palsy. N Engl J Med, 2007; 357:1598–607. doi:10.1056/NEJMoa072006
    • Chen N, Zhou M, He L, et al. Acupuncture for Bell's palsy. Cochrane Database of Systematic Reviews 2010, Issue 8. doi:10.1002/14651858.CD002914.pub5
    • Teixeira LJ, Valbuza JS, Prado GF. Physical therapy for Bell’s palsy (idiopathic facial paralysis) (Review). Cochrane Database of Systematic Reviews 2011, Issue 12. doi:10.1002/14651858.CD006283.pub3
    • Prednisolone. Electronic Medicines Compendium. www.medicines.org.uk, published 5 July 2012
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    Produced by Natalie Heaton, Bupa Health Information Team, September 2012.

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