Bell's Palsy: 8 Things Doctors Want You to Know

Doctor William C Lloyd Healthgrades Medical Reviewer
Medically Reviewed By William C. Lloyd III, MD, FACS
Written By Karon Warren on August 21, 2020
  • Hispanic doctor explaining pamphlet to client in office
    In most cases, Bell’s palsy is a temporary condition.
    Bell’s palsy, also called idiopathic facial palsy, is a temporary paralysis of the face that usually occurs suddenly on one side of the face. It affects approximately 40,000 people between the ages of 15 and 45 each year, although it can affect any gender at any age. While the exact cause of Bell’s palsy is unknown, there are some risk factors that could contribute to its development. In most cases, the condition resolves itself with minimal treatment. However, in some instances, Bell’s palsy may last longer and require more intensive treatments.
  • Patient Getting an MRI
    1. “Bell’s palsy is a diagnosis of exclusion.”
    The most common cause of facial paralysis, Bell’s palsy is not in and of itself a condition that is readily diagnosed. Instead, Bell’s palsy is a diagnosis of exclusion, says Dr. Garni Barkhoudarian, MD, neurosurgeon and director of the Pacific Facial Pain Center at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, Calif. “This means that other causes of facial weakness—stroke, brain tumor, Guillain-Barre syndrome, ALS, trauma, post-surgical, infection, etc.—should be ruled out,” he says. “A thorough evaluation of the entire body as well as laboratory workup and neuroimaging is necessary before concluding one has Bell’s palsy.”
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    2. “There are numerous risk factors for Bell’s palsy.”
    Although the cause of Bell’s palsy is unknown, there are numerous risk factors for the condition. These include diabetes, hypothyroidism, obesity, upper respiratory ailments, hypertension and preeclampsia. “This condition can affect both genders equally, though pregnancy does increase the risk three-fold,” Dr. Barkhoudarian says. “It’s unclear why this occurs. The elderly are at higher risk as well.” He also states that, in many cases, a viral infection precedes Bell’s palsy by 1 to 2 weeks. “It is thought that such an illness can trigger herpes virus, which typically sits dormant in the facial nerve body, to activate and cause painless facial weakness,” he says.
  • man cooking food on stove
    3. “Often underreported, abnormal taste sensation is one of the first symptoms.”
    Bell’s palsy symptoms include irritation of the eyes, partial paralysis of the face, eye or mouth drooping, and abnormal taste sensation. “Abnormal taste sensation is one of the first symptoms of Bell’s palsy and is underreported,” says Dr. Gary Linkov, ENT, facial reconstructive surgeon at City Facial Plastics in New York. “This can make eating significantly less pleasant and make the recovery process even more challenging, as eating may no longer be a source of comfort. Diminished or unusual taste is the only symptom of Bell’s palsy that is not visible but can be equally debilitating as the more obvious facial abnormalities.”
  • Senior man having a stroke
    4. “Bell’s palsy usually comes on suddenly.”
    The onset of Bell’s palsy occurs quickly and without warning. “The typical course of Bell’s palsy is a sudden or rapid onset of facial weakness or paralysis over 1 to 2 days,” Dr. Barkhoudarian says. “This will typically last for a few weeks, with patients starting to recover facial function typically around three weeks, although recovery may take up to nine months.” Once it resolves, most patients are cured. “However, in up to 12% of patients, recurrence may be noted, with multiple recurrences affecting about 3% of patients,” Dr. Barkhoudarian says.
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    5. “The first-line treatment for Bell’s palsy is corticosteroids.”
    Once Bell’s palsy is diagnosed, the first-line treatment is corticosteroids, such as prednisone. “This has been shown to help the rate of recovery,” Dr. Barkhoudarian says. “Often, physicians will also prescribe antiviral medications, simultaneously, given the proposed mechanism of herpes virus reactivation causing the facial weakness.” Ointments and surgical tape also may be used to treat Bell’s palsy, but in the case of it being permanent, surgery is an option, says Dr. Giuseppe Aragona, general practitioner and medical advisor at PrescriptionDoctor.com.
  • Doctor performing acupuncture
    6. “Acupuncture also has been effective in treating Bell’s palsy.”
    In addition to medications, acupuncture has been found to be effective for treating Bell’s palsy, especially when treatments begin early in the disease, says Blake Estape, Dipl. OM, licensed acupuncture physician with Miami Acupuncture and Herbal Solutions Inc. in Miami. “Acupuncture is uniquely suited for helping due to its vasodilative properties and acupuncture-controlled release of neuropeptides,” he says. “When patients turn to acupuncture and herbal medicine as an adjunct to Western medical solutions, they see better results quicker than with traditional therapies alone.”
  • mature woman receiving injection next to her eye
    7. “Botox can provide relief in more severe Bell’s palsy cases.”
    For Bell’s palsy patients who don’t experience recovery in the first three months of onset, botulinum toxin (Botox) often is used to suppress the aberrantly contracting muscles—those muscles that simultaneously pull in opposite directions in a condition called synkinesis, says Jackie Diels, occupational therapist at Facial Retraining LLC in Madison, Wisc. “This allows the normally acting muscles to flex into more normal expressions without restriction from those contracting abnormally,” she says. “Botox would only be used as a treatment in synkinetic patients.”
  • Man using eyedrops
    8. “It’s important to protect the affected eye when Bell’s palsy occurs.”
    Because you won’t be able to blink while experiencing Bell’s palsy, you should take steps to protect the affected eye from potential damage. “Corneal abrasions can occur if the eye is not kept safe, and blindness may result,” Dr. Barkhoudarian says. “The eye should be covered at night with an eye patch or a piece of tape. During the day, the eye can be left uncovered, but artificial tears should be used copiously to prevent scleritis, an inflammation of the white outer coating of the eye.”
Bell's Palsy: 8 Things Doctors Want You to Know
Contributors
  • Dr. Barkhoudarian is a neurosurgeon and Director, Pacific Facial Pain Center at Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, Calif.

  • Dr. Linkov, ENT is a facial reconstructive surgeon, City Facial Plastics in New York.
  • Dr. Aragona is a general practitioner and medical advisor, PrescriptionDoctor.com.
  • Blake Estape, Dipl. OM, is a licensed acupuncture physician, Miami Acupuncture and Herbal Solutions Inc. in Miami, Fla.

  • Jackie Diels is an occupational Therapist, Facial Retraining LLC in Madison, Wis.

  1. Bell’s Palsy Fact Sheet. National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Bells-Palsy-Fact-Sheet

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Last Review Date: 2020 Aug 17
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