Dr. Arun Kumar Dhanuka
MBBS, MD, DM (Neurology)
1799/1, Maharaj Nagar, Ludhiana.
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Bell’s palsy

1) What is Bell’s palsy: Bell’s palsy is an acute condition that causes weakness, or paralysis, to the muscles of one side of theface. The weakness, or paralysis, can also affect the eyelid, so that someone with the condition is not able to close their eye. The cause of Bell’s palsy is unknown, although many researchers believe that theherpes virus is responsible.

2) How common is Bell’s palsy: Bell’s palsy is uncommon condition. Published figures vary, but in England and Wales it is estimated thatevery year, out of every 100,000 people, around 25-35 people develop Bell’s palsy. The condition usuallydevelops between 15-40 years of age, and men and women are equally affected.Bell’s palsy is more common in pregnant women and those with diabetes. The reasons for this are unclear.

3) Prognosis: The prognosis for Bell’s palsy is usually favourable, with 85% of people making a full recovery withinnine months, and most people with the condition noticing a marked improvement in their symptomswithin three weeks.Steroid medications are used to speed up the recovery process. It is important to take good care of theaffected eye during the recovery process.

4) Symptoms: The symptoms of Bell’s palsy develop quickly, often overnight, it includes:
• weakness, or paralysis, in one side of your face, which may make it difficult to close your eyelid, andcause the side of your mouth to droop,
• irritation in the affected eye, due to it being constantly exposed,
• pain underneath your ear, on the affected side of your face,
• an altered sense of taste,
• an increased sensitivity to sound in the affected ear, and
• drooling from your mouth on the affected side of your face.In most cases of Bell’s palsy, the symptoms will begin to improve within three weeks.

5) CausesThe facial nerve: The majority of the muscles in your face are controlled by a single nerve, known as the facial nerve.The facial nerve passes through a narrow gap of bone on its way from your brain to your face. Bell’s palsyis thought to occur because a virus, usually the herpes virus, causes the nerve to becomeinflamed/swollen. If the nerve is inflamed, it will press against the bone.If the facial nerve is compressed, it is likely to become damaged, interfering with the signals that yourbrain is sending to the muscles in your face. The interference results in the weakness, or paralysis, that ischaracteristic of cases of Bell’s palsy.

6) Diagnosis: You should see your neurologist within 72 hours of developing symptoms of Bell’s palsy because studieshave shown that treatment is most effective if it is started within this time period. Your neurologist willlook for any evidence that your symptoms may be caused by another health condition, such as tumor,infection, stroke etc.Diagnosis by exclusion involves carrying out a detailed physical examination of your head, ears, and neck.Your neurologist will also check the muscles in your face in order to confirm whether only the facial nerveis affected.

7) Further testing: If your neurologist is unsure whether Bell’s palsy is the cause, he may refer you for further testing.Possible further tests are described below.
Nerve Conduction Study (NCS)

Nerve conduction study (NCS) is where electrodes are placed on your face, and a machine is used tomeasure the electrical activity in your nerves. Another test known as EMG (Electromyography) can providemore information about the location and extent of any nerve damage, if required.
Imaging scans
Imaging scans, such as a magnetic resonance imaging (MRI) scan, that uses a strong magnetic field toproduce a detailed image of the inside of your body, or a computerised tomography (CT) scan, may beable to detect other causes of your symptoms, such as an infection, or tumour.

Treatment Prednisolone: Prednisolone works by helping to reduce inflammation, which should then help to speed up yourrecovery.Most people with Bell’s palsy are advised to take prednisolone tablets for 10 days.Possible side effects of prednisolone include:
3.abdominal pain,
4.increased appetite,
5.difficulty in sleeping,
6.oral thrush (a fungal infection of themouth),
7.tiredness, and
8.dizziness.However, these side effects should improve within a few days as your body gets used to the medication.As you come to the end of your course of steroid medication, your neurologist may recommend that yougradually reduce your dose. This will help to reduce the possibility of you experiencing any withdrawalsymptoms, such as tiredness, or vomiting.

Eye care: Tears play an important part in helping to protect your eyes by keeping them clean and free of dust, andpreventing bacteria from causing eye infections.However, if your eye is constantly exposed, your tears can evaporate, leaving your eye vulnerable todamage and infection. It is therefore very important to keep your eye lubricated.Your neurologist will give you eye drops, you will need to use during the day, plus an ointment which youshould use at night. If you are unable to shut your eye during the night time, your neurologist will giveyou some surgical tape that you can use to tape your eye shut.
Further treatment
The majority of people who have Bell’s palsy will make a full recovery within nine months. If you have notmade a complete recovery by this time, you may have experienced more extensive nerve damage, andfurther treatment may be required.

Compiled in year 2008.This article is for information only and should not be used for the diagnosis ortreatment of medical conditions. We have used all reasonable care in compiling the information but make nowarranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
Compiled by:-
Dr. Arun K. Dhanuka
MBBS, MD, DM (Neurology)
1799/1, Maharaj Nagar, Near PAU Gate No. 3,Ludhiana (Punjab).Ph: 0161-4662345, 98550-30365, 98147-20265