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Bell’s Palsy

By Sasha de Beausset Aparicio, MSc

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What Is Bell’s Palsy

Bell’s palsy represents a type of facial paralysis that results from a cranial nerve dysfunction which further determines an inability to control certain facial muscles. However, it isn’t a result of a transient ischemic attack or stroke. It can occur in a random way and even though it may not seem serious at the beginning, it is a condition that immediately needs to be checked. The onset of this condition is generally sudden and the manifestation of symptoms tends to peak in less than forty eight hours. Due to this, patients usually go to the emergency department prior to seeing any other medical doctor. In the majority of situations, the condition manifests in the morning because the symptoms need several hours to get noticeable and the paresis is more likely to begin during sleep.

The incidence of Bell’s palsy at an annual scale is of approximately twenty out of one hundred people and it enhances with age. Because of this, the condition is believed to affect somewhere around four hundred thousand individuals per year in the United States. Studies revealed that there is three times more likely for this bodily issue to appear in pregnant rather than non-pregnant women and four times more likely to appear in diabetics as compared to people who have no serious medical condition.
Sir Charles Bell who was a Scottish surgeon discovered it in 1892 and in that year showed three cases of Bell’s palsy at the Royal Society of London. Even though it is named after the Scottish surgeon, there were other physicians who revealed anatomic and biological evidence. Furthermore, some scientific articles point out that this problem has been described from ancient Roman, Persian, and Greek times and between 1400 and 1800.


Despite the fact that further research is needed in order to determine specific causes behind Bell’s palsy, there are some which have an impact on its apparition. Among the main possible causes, there are infections, tumors and Lyme disease.

From all those, the most likely cause behind the occurrence of this disease it’s represented by a virus, according to the expert’s opinion. Generally, the herpes virus which is the one causing genital herpes and cold sores, it is believed to also inflame the facial nerves that may lead to a sudden paralysis. On the other hand, other viruses such as shingles chickenpox, mononucleosis, and cytomegalovirus have also been thought to have a negative impact on this problem.

In areas described by endemics, Lyme disease is often the usual cause that targets it. These causes trigger an inflammation of the nerve. Because of this, the nerve starts pressing against the check bone or pinching in the narrow gap of the bone which further results in a destruction of the nerve’s protecting cover. After the caused damaged, the signals that are sent from the brain to the facial muscles may not be properly transmitted and thus causes a weakness or paralysis of those muscles.

There are some studies that suggest the cause is definitely not the herpes virus. Pauline Lockhart from the Center for Primary Care and Population Research stated that “The evidence from this review shows that antivirals used for herpes simplex offer no benefit for people with Bell’s palsy. These results cast doubt on research that suggests herpes simplex causes the condition.” This conclusion is based on seven trials that include 1987 individuals.

Signs & Symptoms

Because the facial nerves are linked to actions like eye closing, blinking, salivation, smiling, lacrimation, and frowning, there are plenty of symptoms that may appear when this condition has been triggered. Although the most common one is the sudden weakness or paralysis of the facial muscles, there are in fact more bodily problems that are related. For instance, an eye irritation can also appear due to the fact that the person can’t properly blink, thus the eyes become too dry.

Moreover, taste and sense become altered, the individual experiences difficulties linked to his or her facial expressions, the quantity of produced saliva modifies, pain appears behind the ear or on the part that has been affected and sounds can seem louder because the ears have increased sensibility and the sound perception has also been altered.

In some cases, people also experience problems in closing one of the eyelids. Considering this, if an individual experience two or more of these symptoms, she or he should immediately consider a visit to a specialized healthcare provider in order to determine the existence of this condition.

Diagnosis Bell’s Palsy

If a person notices that a part of his or her face has been exposed to a sudden weakness or paralysis, chances are that Belly’s palsy has occurred. It is important to keep in mind that this condition affects only the facial muscles and it is not a result of a stroke or an ischemic attack such as most of paralysis are, but appears unexpectedly.
In order to properly diagnose it, the person should seek a specialized physician. After a series of tests in which evidence of some medical conditions such as Lyme disease or tumors are searched, the person may be told Belly’s palsy is implied. These tests include neck, head, ears, as well as facial muscles checks because it’s the one of the easiest way to notice if the condition that has appeared is indeed Bally’s palsy.

However, there are situations in which a specific diagnosis can’t be put and the patient is referred to an ENT who is an ear, nose, and throat specialist, also known as an otolaryngologist. Some of the tests asked by this specialist include an EMG or electromyography, X-Rays, CT scans, and MRIs. The electromyography is put on the person’s face and is actually a machine that manages to measure the nerve’s electrical activity in order to determine the location and extent of the nerve damage. On the other side, the CT scans, X-rays, and MRIs are ordered with the purpose of determining if other underlying bodily conditions like skull fracture, tumors, or bacterial infections are the triggers of the symptoms.

Treatment for Bell’s Palsy

Until the year 2007, experts haven’t agreed on the main effective treatment for this condition and altered between antivirals and steroids. Further studying pointed out that the steroid treatment is more likely to have a positive impact, specifically a drug named prednisolone which reduces the nerve inflammations and makes it easier for them to recover. Additionally, it prevents the release of some substances which can lead to more inflammation like leukotrienes or prostaglandis. However, consumption of this drug may determine some unwanted side-effects such as breathing difficulties, hives and swelling of the throat, tongue, face, and lips and because of this there are some people who don’t want to follow the prescribed medication treatment.
On 18th October 2007 there was a study published in New England Journal of Medicine which was called “Early Treatment with Prednisolone or Acyclovir in Bell’s Palsy.” The conclusions of the study were the following “In patients with Bell’s palsy, early treatment with prednisolone significantly improves the chances of complete recover at three and nine months. There is no evidence of a benefit from acyclovir given alone or of any additional benefit from acyclovir given in combination with prednisolone.”

Furthermore, according to some sources, this condition is being researched by The National Institute of Neurological Disorders and Stroke which also goes by the name of NINDS. They basically want to support extensive research in order to understand the way in which the nervous system works so they can find a cause behind the system’s dysfunction. A part of this studying concentrates on finding out more about the factors that determine the damaging of the nerves as well as conditions under which damage and injuries are caused. The information obtained from this research can help scientists discover the definitive reason behind the apparition of Bell’s palsy, hence leading to obtaining the best treatment for it so people that have it can benefit from it and receive a proper cure. The other part of the study focuses on creating new methods through which full strength and use of the damaged areas can be restored by having the damaged nerves undergo reparations. If they discover a way in which this can be done, they will also be able to avoid new injuries and prevent any other type of nerve damaging.

For these, other potential natural treatments are suggested. For example, supplements that contain copper, vitamin A, and small additional protein powder are more likely to be of help in these situations. On the other hand, the quantities should be carefully observed and, in case some unwanted effect appears, the utilization should be immediately disrupted. The reason why vitamin A is of help is because it combats the viruses while copper is essential for the health of the nerves due to being an important part of their chemical composition. However, the success of the treatment depends on the quantity utilized as well as frequency of treatment. It is also important to immediately stop any type of supplementation of prescribed medication consumption if any type of side-effect appears in order to avoid causing more harm than good to the organism.

There are also some experimental treatments whose success is currently divided into two sides. While there are some who agreed that it worked for them, others claim the contrary and desire to find another approach. One of these is acupuncture. This apparently produces a sensation named “de qi” which leads a patient to a better facial functioning recovery. As Dr. Jian Kong, assistant professor at Harvard Medical School and Massachusetts General Hospital pointed out, the explanation behind the beneficial effects of acupuncture rely on the fact that they increase blood flow in the area of application. He stated that “so we can provide more nutrition to the nerves and help the inflammation to diminish quickly so people can recover.” Even though it’s still experimental and there are no concrete reasons behind this technique, it seems promising and if proven reliable, it will ease the life of many patients suffering from Bell’s Palsy.


“Bell’s Palsy Fact Sheet” by National Institute of Neurological Disorders and Stroke
“The natural history of Bell’s Palsy” by Peitersen E (1982)