Bell’s palsy
Bell’s palsy is temporary weakness or lack of movement that affects one side of the face.
The condition develops over a 72 hour period. It is important to seek medical advice within this time, because treatment for Bell’s palsy is most effective when started early.
Most people make a full recovery from Bell’s palsy. Improvement can occur within a few weeks; however, a full recovery can take from three to six months and beyond.
The symptoms of Bell’s palsy can be similar to those of a stroke. If you are in any doubt then call 999 immediately.
Remember: FAST
If you are concerned that someone is having a Stroke or TIA (transient ischaemic attack or ‘mini’ stroke), remember FAST:
F – Facial drooping (the mouth or eye may have drooped)
A – Arm weakness (difficulty in lifting both arms and keeping them there)
S – Speech difficulty (speech may be slurred or garbled)
T – Time to call 999
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Causes of Bell’s palsy
Inflammation around the facial nerve, and the resulting pressure, causes paralysis on the affected side of the face.
Bell’s palsy is an ‘idiopathic’ condition – this means that no conclusive cause has been established. Whilst it has not yet been possible to understand why the facial nerve becomes compressed, links have been made to certain viruses (these include herpes, influenza and respiratory tract infections) along with a depleted immune system.
Symptoms of Bell’s palsy
The onset of Bell’s palsy is usually sudden, peaking at 72 hours.
The main symptoms of the condition are:
- Partial or complete paralysis of one side of the face, including the inability to close the affected eye, and a ‘drooping’ of the face. (In rare cases, approximately 1%, both sides of the face are affected).
- Sharp pain in the ear during the onset of paralysis.
- Sensitivity to loud noise.
- Impaired or altered sense of taste.
- Dryness of the eye on the affected side (where it cannot be closed properly). To compensate, this can cause watering.
- Eating can be difficult due to the loss of control of lips and cheek on the affected side. This can result in drooling.
- The nostril on the affected side may stream due to loss of muscle control.
- Speaking clearly and pronouncing certain sounds and letters may be difficult.
- Unwanted facial movements, such as twitches, which is called ‘synkinesis’.
Diagnosis of Bell’s palsy is made by ruling out other possible causes. A neurological examination is carried out – the doctor will ask the sufferer to carry out a range of facial movements. A diagnosis of Bell’s palsy is likely if there has been rapid loss of the use of one side of the face and if there are no other symptoms.
Other tests may include blood tests, scans (MRI – magnetic resonance imaging or CT – computerised tomography), ENT (ear, nose and throat) specialist checks or a nerve test (EMG – electromyography) to ascertain any facial nerve damage.
Your doctor might also consider:
- Stroke – Bell’s palsy is the most common cause of sudden facial weakness, but a stroke should always be ruled out as a precaution.
- Ramsay Hunt syndrome – If there is severe pain around the ear usually followed by a rash of blisters in or around the ear, scalp or hair line, or in the mouth or throat.
- Lyme disease – If there is a history of tick exposure, or a rash (not always present). If there are flu-like symptoms, joint pain or tiredness.
With Bell’s palsy, the entire half of the face is affected, whereas typically with a stroke, the forehead is unaffected. Also, in Bell’s palsy there is no weakness of the limbs.
Bell’s palsy is the most common cause of facial paralysis – accounting for 60% of cases. In the UK it affects between 12,400 and 24,800 people per year1. People between the ages of 15 and 60 years are most commonly affected2.
Sources:
- https://www.facialpalsy.org.uk/causesanddiagnoses/bells-palsy/
- NICE Clinical Knowledge Summaries October 2012.
Treatments for Bell’s palsy
Medication
Prednisolone is the steroid usually prescribed for the treatment of Bell’s palsy and has been shown to reduce the severity of an attack. After 72 hours, there is no evidence that steroids are effective. In some cases, despite early treatment with steroids, patients do not fully recover.Eye care
This is extremely important in the initial stages of Bell’s palsy. As it is likely that a sufferer will not be able to close their eye fully, it should be kept moist and protected with drops or ointment. Surgical tape may also be used to keep the eye closed at night.Botox
While better known for smoothing wrinkles, botox's ability to gently relax targeted muscles can be very useful in the treatment of Bell's palsy symptoms. Botox can help you control overactive muscles to prevent unwanted facial movements (synkinesis) and reduce the activity of muscles on the unaffected side of your face to improve symmetry.CACI
CACI treatment for Bell's palsy uses electrical impulses, combined with muscle re-education, to trigger a stretch reflex response in the affected muscles. Expert use of the CACI system can relax facial muscles which have become too tense, while contracting muscles which have weakened, resulting in a more balanced appearance.Our Bell’s palsy treatments
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FAQs
I think I have Bell’s palsy, what should I do?
If you suspect that you have Bell’s palsy, then you should visit your GP or attend A&E as soon as possible. It is important to seek medical advice within 72 hours of onset, as research indicates that this is the optimum period in which Bell’s palsy will successfully respond to treatment.
Is it normal for the Bell’s palsy side of the face to suddenly feel very bruised one week in?
Yes it can feel tender both early on and later on too if synkinesis sets in (overactivity of some facial muscles and the resulting unwanted movements).
Are there exercises I can do to make my face recover quicker?
When your face is not working as it should, it is tempting to force the muscles back to work by doing facial exercises.
There is evidence to suggest that exercising the facial muscles too forcefully can lead to a miswiring of the nerves as they recover, leading to longer term complications. Gentle facial massage is preferable, using the pads of your fingers to gently massage your face.
Should I take time off work with Bell’s palsy?
It is important to get plenty of rest even if you have no other symptoms. You should also maintain a healthy diet. If you are at work or school, it may be necessary to take some time to recover.
Further reading about Bell’s palsy
If you’d like to learn more about Bell’s palsy, its causes and treatment options, here are some trusted resources:
- Bell’s palsy treatments at Melior Clinics – Find out more about how we use targeted botox and CACI facial therapy to support recovery and facial symmetry.
- NHS: Bell’s palsy overview – Read about symptoms, causes, and treatment guidance from the NHS.
- Bell’s palsy – what you need to know – A helpful summary from the U.S. National Institute of Neurological Disorders and Stroke.
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