What is Bell’s palsy?

Bell’s palsy is a weakness or paralysis of a facial nerve. Nerves on each side of your face control movement of the muscles on that side. When a facial nerve is weak or paralyzed, that side of your face droops and it may be hard to smile or close your eye on that side. The severity of Bell’s palsy can vary from mild weakness to complete paralysis of one side of the face.

What is the cause?

The exact cause of Bell’s palsy is not known. One possible cause is that a virus, or your body’s reaction to a virus, has caused swelling or irritation that damaged the facial nerve. When this happens, the nerve can no longer control the facial muscles. The muscles get weak and you lose part or all control of the muscles for weeks or months until the nerve heals.

Lyme disease, an infection caused by the bite of an infected tick, is another possible cause.

What are the symptoms?

The first symptom may be an ache behind the ear. Then that side of the face will become weak or paralyzed.

Other symptoms may include:

• Watery eye
• An eye that won’t close completely
• Decreased taste
• A change in hearing
• Trouble smiling, drinking, or chewing on one side of your mouth
• Slurring of your words when you talk

Symptoms may develop within a few hours or over a couple of days. The faster the symptoms happen, the more severe the weakness or paralysis is likely to be.

Get help from a healthcare provider right away if your symptoms develop quickly–for example, in 30 to 60 minutes. Your provider will want to make sure that you are not having a stroke.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. You may have tests or scans to check for other possible causes of your symptoms, such as a stroke or tumor.

How is it treated?

If your symptoms are mild, you may not need treatment. Symptoms will start to go away on their own within a few weeks. If your symptoms are more severe, your provider will prescribe steroid medicine and may also prescribe antiviral medicine.

Using a steroid for a long time can have serious side effects. Take steroid medicine exactly as your healthcare provider prescribes. Don’t take more or less of it than prescribed by your provider and don’t take it longer than prescribed. Don’t stop taking a steroid without your provider’s approval. You may have to lower your dosage slowly before stopping it.

Physical therapy, including exercises and massage, may help you keep some muscle strength and keep your facial muscles flexible until your symptoms go away.

Biofeedback is helpful for some people. A multivitamin and mineral supplement may also be recommended to help your symptoms.

If your eye does not close completely, it needs to be protected from problems such as dust and dryness. Patching your eye or using eyedrops or eye ointments can protect your eye. If your eye is not protected, you could lose vision in that eye.

If, despite the weakness, you still have at least some muscle movement, you have a good chance for a complete recovery. If you have complete paralysis (no movement of the facial muscles at all), you will probably not get back full muscle movement. Bell’s palsy can last several weeks even when it’s mild. It may be months before you know how much muscle control you will get back.

It’s rare to have Bell’s palsy more than once. If you have facial paralysis again, another problem may be causing it and you should get it checked right away by your healthcare provider.

How can I take care of myself?

• Follow the full course of treatment prescribed by your healthcare provider.
• Take nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
  • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
  • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don’t take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
• Moist heat may help relieve pain, relax your muscles, and make it easier for you to move your face muscles. Moist heat includes moist heating pads that you can buy at most drugstores, a warm wet washcloth, or a hot shower. To prevent burns to your skin, follow directions on the package and do not lie on any type of hot pad. Don’t use heat if you have swelling.
• Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the area every 3 to 4 hours, for up to 20 minutes at a time.
• Try gentle facial massage to help you get back more muscle movement as you recover.
• Acupuncture, electrical stimulation or biofeedback training may help. Ask your healthcare provider about this.
• If your eye is not closing completely, keep it moist. Some things that might help keep your eye from getting too dry are:
  • Use artificial tears when you are awake.
  • Use eye lubricant ointment when you are sleeping. The ointment may be used also when you are awake if artificial tears don’t give enough protection. However, the ointment may blur your vision. Your provider may recommend that you use an eye patch to make sure your eye stays moist when you sleep.
  • Wear eyeglasses or a shield to protect your eye. Wear sunglasses when you are out in the sun.
  • Take extra care to keep your eye moist when you are working on a computer. People tend to blink less often while at a computer. If it’s hard for you to blink, you can use the back of your index finger to move your eyelid down over your eye. Keep eyedrops handy.
• Take care of your health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet and try to keep a healthy weight. If you smoke, try to quit. If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink. Learn ways to manage stress.
• Ask your healthcare provider:
  • How and when you will hear your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup.