Last updated date: 30-Aug-2023
Medically Reviewed By
Medically reviewed by
Dr. Lavrinenko Oleg
Originally Written in English
Bell’s Palsy Disease
What is Bell’s Palsy?
Bell’s palsy disease is a form of facial paralysis, usually temporary, that causes paralysis or weakness of the muscle on one side of the face. It occurs as a result of a dysfunction of a cranial nerve, the facial nerve VII. This nerve is responsible for controlling the muscles responsible of facial expressions and the movement of the eye. This means that your face droops on one side and one eyelid might close. In some rare cases, both sides of the face can be affected. It can affect anyone, no mater the age and gender. However, people between the ages of 15 to 45 are thought to have a higher risk of having it. Some research shows that people older than 60 are also at a higher risk of developing Bell’s palsy.
The condition was named after Sir Charles Bell who was a Scottish surgeon, neurologist and artist, amongst other things, that discovered and described the disease in the 19th century. He is now noted for his discoveries regarding the difference between sensory nerves and motor nerves located in the spinal cord. He combined his medical and anatomical knowledge with his talent and produced plenty of incredibly well draw illustration that he published in book formats. In his writing about Bell’s palsy he described Bell’s spasm, the involuntary twitching of the facial muscles. Also, he explained the Bell’s Law which states that the anterior of the spinal nerve roots contain just motor fibers and the posterior one contains just sensory fibers.
The person usually wakes up one day not being able to move one side of the face and the symptoms worsen in the first few days. It begins to improve after a few weeks without need for treatment. The person will recover all functions of the face in the next six months. It is rare but it is possible for muscle weakness to last longer and need additional treatment or be permanent. Some cases do require treatment and you should contact your doctor as soon as you get the first symptoms either way. Home remedies are available and will we discuss about them later in this article.
Bell’s Palsy Cranial Nerve
The VIIth cranial nerve, the facial nerve is the considered to be the Bell’s palsy nerve and it controls the motor function of the face. The nerve supplies all the muscles involved with facial expression. When is damaged or when Bell’s palsy occurs, weakness of the muscles of the face and eye is present. The inability to close the eye can cause damage to the cornea and conjunctiva. It can become difficulty for the person with this nerve affected to eat. Bell’s palsy usually causes partial paralysis, when mostly the lower face affected. Your doctor is the one to determine the correct diagnosis based on these symptoms and their level of severity.
Bell’s Palsy symptoms
Most common symptoms of Bell’s palsy are headache, drooling, loss of feeling in the face (usually one side of the face), a tearing eye, difficulty raising the eyebrows, disordered movements of the face (loosing movement or control over facial expressions, difficulty blinking and closing the eyelid). Less common symptoms include hypersensitivity to sound known as hyperacusis (being irritated or hearing sounds louder then they actually are), inability to close one eye on the affected part of the face, loss of taste or having a less sense of taste, dry eye and mouth, tinnitus (hearing ringing in your ears), trouble talking, severe pain in the jaw, ear and, overall on the side of the face that is affected, difficulty eating or drinking. In most cases, the speech is altered and, very rarely, the person with Bell’s palsy is unable to talk. Some people also report pain around the ears, feeling their face heavy and dizziness or generalized confusion.
Bell’s Palsy causes
Bell’s palsy does not have a clear cause but is thought to occur because of an inflammation of the nerve when it is damaged so that the signals to the muscles are not transmitted in a favorable manner by the brain.
One cause for the inflammation may be contacting a virus, mostly a herpes virus. Herpes viruses can cause genital herpes and cold sores and it is more common for people with compromised immune systems to contact a herpes virus. In some rare cases, the herpes virus cand cause Bell’s palsy disease.
Cytomegalovirus (known as HCMV) is one of the most common herpes viruses. Many people have the virus but they do not know about it and they do not have any symptoms. For people with weakened immune system is more common to spread through bodily functions and it can be transmitted from the mother to the unborn baby during pregnancy. Most of the adults, both men and women, contract the virus by the age of 40 researchers say. Symptoms include joint and muscle pain, fever, tiredness, swollen glands, sore throat and low appetite. The virus cand affect the eyes, digestive system or lungs. More severe symptoms are pneumonia or low blood oxygen, mouth ulcers, blind spots and blurred vision, hepatitis, prolonged fever, gastrointestinal ulcerations and bleeding, acute diarrhea and encephalitis leading to even coma. If you think you have a week immune system you should reach out to your doctor as soon as you can. People who have congenital HCMV at birth may have enlarged spleen, liver or pneumonia. Also, having HIV can play a significant risk factor.
Other viruses that can cause Bell’s palsy disease include influenza B, Rubella, Coxsackievirus, adenovirus and herpes zoster. Bell’s palsy caused by varicella zoster is called Ramsay Hunt syndrome. The cranial nerves can be affected and it can include deafness. In Ramsay Hunt syndrome is more painful than other forms of Bell’s palsy caused by viruses and people over the age of 60 are more likely to develop Ramsay Hunt syndrome. Immunodeficiency, caused by HIV for example, can be a serious risk factor.
Bell’s palsy in pregnancy and other conditions
Bell’s palsy is thought to be more likely to happen if you are pregnant, in the first week after you give birth or during the last three months of pregnancy. Also, as we mentioned before, you are more likely to have it if you have a compromised immune system. This includes having diabetes, respiratory infection (cold or flu), high blood pressure, mononucleosis, cold sores (herpes virus), chickenpox, shingles virus, coxsackievirus. Also, people with a family history of Bell’s palsy are more likely to have it.
Is Bell’s palsy contagious?
Bell’s palsy is not contagious and it can’t be transmitted between an ill person and a heathy one. However, herpes viruses and other viruses can be transmitted between an infected person and a heathy one, especially if the infected person does not know has the virus or if the person does not have any symptoms.
Bell’s Palsy vs. Stroke
Most people who have Bell’s palsy think they are having a stroke. It is important to contact your doctor immediately. Your doctor can determine if it is Bell’s palsy or other condition based on the symptoms, including stroke or sarcoidosis. These conditions also cause facial paralysis. Your doctor may want to get you to have one or more tests to give you the right diagnosis. These tests may be blood tests, electromyography (EMG), magnetic resonance imagining (MRI) or computed tomography (CT) to rule out any other conditions, including Lyme disease. Lyme disease is a disease caused by infected tics and can have severe damage to your immune system and nervous system. Each of these conditions are serious and should be treated as such. Be careful about contacting your doctor if you are experiencing any of the mentioned symptoms. The doctor may want you to get a MRI or CT scan to see the nerves in your face. Although Bell’s palsy usually goes away after a few weeks with full recovery over the course of a few months you should not treat this disease lightly and treatments are available, even it is just about managing Bell’s palsy pain.
Bell’s palsy child symptoms and treatment
Bell’s palsy can affect children and it has the same symptoms as the adults who have it. Most likely, children who have Bell’s palsy get it from their mother as a result of a viral infection or after having chickenpox. Some doctors request a radiological investigation only if there is a history of head trauma. Bell’s palsy can be particularly tough for children because they get frightened, as the appearance is drastically affected. The damage of the face can cause trauma and parents should be very careful when taking care of children with Bell’s palsy disease. If you are a parent with a child that has Bell’s palsy you may want to consider talking to their teachers, coaches and school counselors. You can look for a licensed psychologist for more help if you feel like your child is overstressed about the condition or he is being bullied by school mates. Be patient with he or she and reassure them that it is just temporary. Also, you may want to make sure that the class colleagues understand that the condition is not contagious and they cannot be affected directly. Some extra love and fun activities for your child may help them get through it more easily. You want to test your child as soon as possible and make sure he is fed, as feeding is harder because of the numbness of the face. All in all, the prognosis is usually good and Bell’s palsy in children is mostly idiopathic. More research is being done to investigate this disease on children, long-term implications, causes and variability of symptoms.
Bell’s palsy treatment
Bell’s palsy can be treated with medication. The symptoms improve without any treatment but the treatment reduces pain and it improves the condition considerably faster. Medication can help you in your recovery. This includes corticosteroid drugs for reducing inflammation, over-the-counter medication, for relieving the pain (ibuprofen and acetaminophen), eye drops for keeping your eye or eyes from getting dry, as you may not be able to close them and antiviral medication or antibacterial medication for a virus or bacteria that caused Bell’s palsy. Also, one prescribed common antiviral medicine is acyclovir but none of the listed above medication should be taken without doctor’s supervision.
It is not just children that can struggle with mental health while dealing with Bell’s palsy. Adults can withdraw socially because they feel shame around their appearance. Over worrying and feeling anxiety around outcomes are also common among people who have had this disease. Monitor your negative thoughts and your mental health in general. Seek support among friends and family and talk to a therapist if you feel like you need external help. Having this disease can have a great impact on people from a psychological perspective, as the appearance changes drastically and other people may have weird reactions. Know that most people get over it with no to little intervention.
You can also treat you Bell’s palsy at home through remedies such as an eye patch, for your dry eye or eyes, a moist towel over the face or the part of the face that is affected to reduce the pain, facial massage given by you or another person you feel comfortable with, exercises for physical therapy to stimulate facial muscles that are affected. All these remedies help with relieving the pain and to regain some of the mobility. Relaxation exercises help with pain release too. Physical therapy should be used no matter the severity of your Bell’s palsy disease and can be done at home. Another treatment for Bell’s palsy disease are steroids for reduction of inflammation. Other alternative remedies for Bell’s palsy are acupuncture and vitamin therapy with vitamins B12, B6 and zinc.
Facial nerve decompression is a surgery optional for those with Bell’s palsy that do not respond to medical treatment. You can consider plastic surgery if you have residual paralysis after 6 months. Ask your doctor if it would be appropriate to get a reconstructive surgery. Other kind of surgery that is available for Bell’s palsy is cosmetic surgery for mouth or eye to elevate them. Some rare cases have severe facial asymmetry and brow ptosis after having Bell’s palsy.
Bell’s palsy exercises
Bell’s palsy exercises include Bell’s palsy facial exercises in which you move your mouth side to side, front to back. You can also try to move your tongue or just your lips. Trying to move your eyelid or just your eye may also help. Your doctor can guide you towards local help.
Exercises to help Bell’s Palsy help to increase strength muscle and to regain coordination in the face. Besides facial exercises, physical therapy is recommended for this temporary paralysis. Exercises can be done in short sessions, four times a day. Repetitions per exercise can go up to 30. First, it is important to warm up your facial muscles. Sitting in front of a mirror helps you see your face clearly and control your muscles better. Try and move every part of your face but be careful to do it with slow movements. Do not apply too much force and be gentle. Lift your eyebrow and massage the different parts of your face with your fingers. Massage your mouth, nose, forehead, cheeks and chin. Start with your cheeks and nose, move to your mouth and then focus on practicing exercises for your eyes. It can be difficult to move your eye but it helps you regain control to the muscles around the eyes. You can combine these exercises with gentle massage of the eyelids.
It is safe to do Bell’s palsy exercises and massage at home but do not overdo it. If your muscles are moving or pulling you should stop and try again the next day or take a longer break to relax your muscles as much as you can.
Bell’s palsy Acupuncture
Acupuncture is a controversial remedy for Bell’s palsy disease and is common in Chinese culture. The current literature is insufficient to support that this alternative treatment is effective as a therapy for reducing or recovery for Bell’s palsy disease. However, some people report really benefiting from this kind of treatment and it seems that it is valuable to be taken into consideration. You should consult your doctor regardless of the treatment you choose. Make sure the treatment does not produce more damage than good. There are many variables to take into consideration when getting acupuncture treatment for Bell’s palsy disease and some people benefit from it as a placebo effect. Improvement, as stated before, does come naturally, without any treatment whatsoever.
Acupuncture is a traditional Chinese medicine or TCM and in this culture, this disorder is a result of the wind factor. This wind attacks the meridian channels of your face and are transporting blood and vital energy to your face. Underlying vital energy deficiency is present in those who develop Bell’s palsy disease. The wind can be cold or hot. Exposure to bad weather causes stagnation of blood circulation and prolonged heat exposure results in fever, pain and a sore throat. The goal of acupuncture is to eliminate the wind present in the channels. Acupuncture involves stimulation of the facial area and restoring the movement back to the facial muscles. For enhancement of nerve function and for recovery it is recommended for acupuncture treatment to be done at least once a week. In the recovery stage it is important that the vital energy is restored and avoid complications like facial muscle spasms and permanent changes in the person’s facial expressions.
One study indicates that stronger stimulation in acupuncture intervention while in the acute stage of Bell’s palsy (within 10 days from onset) can be more efficient than an acupuncture with no stimulation.
According to traditional Chinese medicine, the most important objective is to unblock Yangming and Shaoyang channel obstruction.
Bell’s palsy recovery time
Bell’s palsy gets worse in the first few days and pain may be experienced in the first weeks. In up to 6 months’ time (sometimes 3 months), most of the symptoms should be gone and the person should be able to move their face without any discomfort. It is the same for children, although they do require special attention from the parents and doctors. The safety of acupuncture is unknown especially in the case of children. Bell’s palsy nerve is the prime one affected in this disease and home treatments help relieve the symptoms. As we previously mentioned the natural recovery takes approximately 6 months with no long-term complications. Most people who are affected cannot close the eye and therefore keeping the eye dry is very important. To protect the eye, make sure you are careful during the night and while working on a computer screen. You need to protect the cornea from scratching. Take medication as directed and keep your healthcare provided posted. If the symptoms worsen after the first weeks you should address your doctor as soon as possible. Do not panic and try to stay as positive as possible as most health conditions are shown to be linked to the level of stress you are experiencing.
To sum it all up, 85% of cases improve within 3 weeks of onset with no intervention. Most of the cases, 70% of people who develop Bell’s palsy recover fully. Only a small percentage of people who had the disease experience inadequate lid closure, drooling and hemifacial spasms after half of a year. Severe pain and degeneration are thought to happen to people over the age of 60 and to people with severe immunity problems, or other major life-long battling diseases.
Bell’s palsy and COVID-19
Some of the people who had COVID in the past are thought to develop a higher risk for Bell’s palsy disease. However, there is no available conclusive data to support that statement. People who have Bell’s palsy can get the Covid-19 vaccine. The cases included in COVID trials who had Bell’s palsy are not thought to have it because of the COVID vaccine. One study shows that individuals who received mRNA vaccines are 2-3 times more likely to develop facial paralysis than people who receive traditional vaccines. Pfizer-BioNTech vaccine has a higher frequency of facial paralysis after taking it then the Oxford-AstraZeneca vaccine has.
If you had Bell’s palsy in the past you should consider having the vaccine although the link between Bell’s palsy and Corona Virus are inconclusive. Patients who had Bell’s palsy in the past should receive special care and monitorization from their doctors.
Medically Reviewed By
Medically reviewed by
Dr. Lavrinenko Oleg