Q: Two weeks ago, I noticed that my face was slightly droopy on one side, so I immediately went to my doctor. He was able to rule out a minor stroke and told me I most likely have Bell’s palsy. What caused this, and will it really take care of itself, as he suggested?
A: You did the right thing by going to your doctor when you noticed the slight drooping. Anytime half of your face seems to abruptly weaken or go limp, it’s important to quickly get to the emergency department since this could mean you’re having a stroke.
The nerve that controls your facial muscles passes through a narrow corridor of bone on its way to the face. If the nerve becomes inflamed or swollen, typically due to a viral infection, it can become compressed, irritated and injured in this corridor, resulting in Bell’s palsy.
Bell’s palsy can occur in anyone, but the risk rises until about age 40, and then begins to decline. In addition, the condition occurs disproportionately in people who’ve had recent viral infections — such as cold sores or upper respiratory infections — and those who have Lyme disease or diabetes.
Damage to the nerve can lead to a diverse range of problems that begin fairly abruptly and usually reach their maximum level within one to three days. Signs and symptoms include:
• Loss of muscle function that can range from mild weakness to total paralysis, occurring on one side of the face. The majority of those with Bell’s palsy don’t experience total paralysis.
• A dry, irritated eye with tears dripping from the corner. This occurs because you can’t close the eyelid on the affected side.
• Pain around the ear or jaw area, a ringing in your ear, or sensitivity to noise.
• Headache.
• Loss of taste or a decrease in saliva production.
As you probably found out, there’s no test that can confirm a diagnosis of Bell’s palsy. The diagnostic process involves eliminating other conditions that can cause similar facial paralysis. These include stroke, tumors, inner ear infections, multiple sclerosis, certain autoimmune diseases or shingles that may affect the nerves of your face. In addition, Lyme disease can cause Bell’s palsy, and it can involve both sides of the face.
Many subtle differences — such as gradual rather than abrupt onset, paralysis of both sides of the face, a lack of weakness or paralysis of the forehead of the affected side — would have suggested to your doctor some problem other than Bell’s palsy.
For most, symptoms of Bell’s palsy begin to improve within a few weeks. Complete recovery may take three to six months, or even longer in severe cases. About 85 percent of those with Bell’s palsy will experience full recovery of nerve function, even without treatment. The 15 percent of people who don’t fully recover are almost always those who experience total paralysis.
Doctors sometimes prescribe a course of oral corticosteroids in an attempt to reduce inflammation around the facial nerve. This increases the number of people who fully recover and may help shorten the duration of recovery. Antiviral drugs have also been studied as a potential means of improving recovery; however, there’s some controversy as to whether these are of benefit. In very rare cases, facial nerve decompression may be done to surgically widen the bony opening that the facial nerve passes through.
If you don’t experience a complete recovery, you may benefit from surgical procedures to lift a drooping eyebrow or corner of the mouth. Injections of botulinum toxin (Botox) to temporarily paralyze certain muscles on the nonparalyzed side of the face may help to make your face appear more symmetrical.
Dr. Colin Driscoll, Otorhinolaryngology, Mayo Clinic, Rochester, Minn.;
