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What
Is Bell’s Palsy?
Neil S. Lava, MD
It
affects only one side of the face at a time, causing it to droop or become
stiff on that side.
It’s
caused by some kind of trauma to the seventh cranial nerve. This is also called
the “facial nerve.”
Bell’s
palsy can happen to anyone. But it seems to occur more often in people who
have diabetes or
are recovering from viral infections.
Most
of the time, symptoms are only temporary.
If
it happens to you, you may fear you’re having a stroke. You’re probably
not.
A stroke that
affects your facial muscles would cause muscle weakness in other parts of your
body, too.
What Causes It?
Most
doctors believe that it’s due to damage to the facial nerve, which causes
swelling. This nerve passes through a narrow, bony area within the skull.
When
the nerve swells -- even a little bit -- it pushes against the skull's hard
surface. This affects how well the nerve works.
Researchers
have long believed that viral infections may
also play a role in the development of Bell's palsy.
They’ve
found evidence that suggests the herpes simplex 1
virus (a common cause of cold sores)
may be responsible for a large number of cases.
Symptoms of Bell’s Palsy
The symptoms of Bell’s
palsy tend to come on all of a sudden. You may go to bed one night feeling
fine. But when you look in the mirror the next morning, you see that part of
your face seems to be drooping.
Some people feel pain behind their ear 1-2
days before they notice any weakness. Others say that sounds seem much
louder than normal in the days before they see any other symptoms.
You might also notice the
following things before the onset of Bell’s palsy (remember that these symptoms
will probably only happen on one side of your face):
· You’re unable to close your eyelid or blink
· Your eye waters more or less than usual
· Drooling
· Difficulty chewing
· Decreased sense of taste
· Your facial muscles twitch
· Pain or numbness behind your ear
Facial weakness and
drooping typically reach their peak within a day or two. Most people start to
feel better within a couple of weeks.
They usually recover
completely within 3 months. Some people who develop Bell's palsy have a longer recovery
period.
In rare cases, they may
have some permanent symptoms.
How Bell’s Palsy Is Diagnosed and Treated
There’s
no test that can tell you for sure if you have Bell’s palsy. In fact, doctors
usually find out through what they call a "diagnosis of exclusion."
That
means in most cases, they determine you have Bell's palsy only
after other conditions have been ruled out.
Your
doctor will start by doing a complete and careful physical exam.
If
he suspects you have Bell’s palsy, he’ll try to close your eyelid on the
affected side of your face. If it doesn’t close, it’ll signal that you have
what doctors call “the Bell phenomenon.”
With
this condition, your eye rolls
upward and outward when you try to close it.
Your
doctor will then try to rule out other conditions. He’ll probably test your
hearing and sense of balance.
He
may also order several tests, such as skull X-rays, a computed tomography (CT)
scan, or magnetic
resonance imaging (MRI).
Electrical
testing may help clarify the diagnosis. It may also help him predict how fast
and fully you’ll recover.
Treatments for Bell's Palsy
There
aren’t any that can stop it.
If
your doctor suggests your symptoms might be triggered by the herpes virus
(herpes simplex 1)
or by shingles (herpes zoster),
he may give you an antiviral medication, like acyclovir.
But
there’s no research to show these medications work to
reduce Bell’s palsy symptoms.
Your
doctor may also give you a short course of corticosteroids (like prednisone).
The goal is to decrease swelling of your facial nerve. This may shorten the
duration of your Bell's palsy symptoms.
In
the meantime, your doctor will tell you to take extra care to protect
your eye on
the affected side.
He
may suggest you wear an eye patch,
since you won’t be able to blink. If your eyes are
tearing less than normal, you may have to use eye drops
to keep them from drying out.
Finally,
your doctor may suggest massage of
your facial muscles.
In
very rare cases -- where symptoms don’t improve after some time -- he may
suggest surgery to reduce pressure on your facial nerve.
Neil S. Lava, MD, is the director of the multiple sclerosis clinic
at Emory University in Atlanta. He has been treating multiple sclerosis
patients since 1984.
Lava graduated from the
University of Medicine and Dentistry of New Jersey in 1973. After an internship
in internal medicine in Buffalo, NY, he received his neurology training at the
Albany Medical College in Albany, NY. He served a 2-year fellowship in
neuromuscular diseases at the University of Colorado, Denver, and returned to
Albany to join the faculty of the Albany Medical College. He started the
multiple sclerosis clinic at the Albany Medical College and was director of the
clinic until 2007. He also served as director of the residency training program
for a few years and was interim chairman of neurology for 3 years. He joined
the faculty of the department of neurology at Emory University as an associate
professor of neurology and director of the multiple sclerosis clinic in
2007.
Lava was elected to the
National Multiple Sclerosis Society (Upstate New York Chapter) Volunteer Hall
of Fame in 2006. He serves on the board of directors of the Georgia chapter of
the National Multiple Sclerosis Society. He belongs to the Consortium of
Multiple Sclerosis Clinics and is a fellow of the American Academy of
Neurology.
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