Bell's Palsy

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Signs and Symptoms

The most common symptoms of Bell's palsy are facial weakness or paralysis, a dry eye or mouth, and problems tasting. The severity of symptoms depends on the extent of facial nerve damage and varies from mild weakness to complete paralysis. Bell's palsy usually affects both the upper and lower parts on one side of the face. Both sides of the face are affected in less than 1% of cases.

Symptoms usually come on suddenly; in about 60% of cases, patients are recovering from a recent upper respiratory infection or other viral infection. Several hours before the onset of facial weakness, many people experience pain behind the ear or in the back of the head. In addition to paralysis of the face, other symptoms include the following:

• Dizziness
• Drooling
• Dry mouth
• Facial twitching
• Hypersensitivity to sound
• Inability to blink or close the eye, tearing, and dry eyes
• Impaired sense of taste
• Impaired speaking

Bell's palsy is self-limiting. Symptoms do not spread beyond the face and do not worsen once they "peak." Between 60% and 80% of patients experience complete recovery within a short time, whether or not they receive treatment. Others are left with varying degrees of facial disfigurement, paralysis, or muscle spasms.

Recovery time varies from a few days to a few months, depending on the amount of damage to the facial nerve. Approximately 7–10% of patients experience a recurrence.

Diagnosis

A diagnosis of Bell's palsy is often based on symptoms and by ruling out other disorders. Other conditions that may cause facial paralysis include facial tumors, certain cancers, and autoimmune diseases. The physician can usually exclude other disorders by taking the patient's history of symptoms, and by examining the head, neck, ears, and eyes.

During the physical examination, the doctor observes the patient's range of movement in different parts of the face (e.g., raising and lowering the eyebrows, closing both eyes). If one eyebrow cannot be raised or can only be lifted slightly, it suggests that one side of the face is weaker. Similarly, if one eye cannot be closed tightly, it indicates a problem with the controlling muscles. If paralysis or muscle weakness is noted in another part of the body, Bell's palsy may be ruled out through diagnostic testing.

Imaging tests such as computerized tomography (CT scan) or magnetic resonance imaging (MRI scan) are used to detect infection, tumor, bone fracture, or other abnormality in and around the facial nerve.

Hearing and balance tests are used to determine if the nerve responsible for hearing is also damaged and assess injury to the inner ear. Tests can be performed to evaluate the eye's ability to produce tears. The sense of taste also can be evaluated to determine the location and severity of a facial nerve lesion.

Electromyography (EMG) assesses injury by electrically stimulating the facial nerve. Electrical current is applied to the skin over the nerve and nerve function is determined by the amount of current needed to cause contraction of the facial muscles. The test is often repeated to assess disease progression and the extent of injury.

Laboratory tests can help the physician determine the underlying cause. For example, a blood test for Lyme disease may be ordered if there is a chance that the patient was bitten by a deer tick, or a blood glucose test may be obtained to determine if the patient has undiagnosed diabetes.

Bell's Palsy, Signs and Symptoms, Diagnosis reprinted with permission from neurologychannel.com
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