Bell’s Palsy: Causes, Symptoms & Treatment


What Is Bell’s Palsy?

Bell’s Palsy, or facial palsy, is a paralysis or severe weakness of the facial muscles on one side of the face. This may be a result of swelling of the nerve that controls the muscles of the face. It is characterized by weakness or paralysis on one side of the face. Its symptoms usually appear in the morning, when a person wakes up and finds that one side of their face does not move. A sufferer may find that they suddenly cannot control their facial muscles, usually on one side. The affected side of the face tends to droop. This weakness may also affect tear and saliva production, as well as the sense of taste. A number of people who experience this are afraid they are having a stroke, however, when the weakness or paralysis only affects the face, it is more likely to be Bell’s palsy than a stroke. This condition is rare, as it only affects approximately 1 in 5,000 people each year. In extremely rare cases, Bell’s palsy affects both sides of the face.

Causes of Bell`s Palsy

The facial nerve controls most of the muscles in the face and parts of the ear. The facial nerve passes through a narrow gap of bone from the brain to the face. Inflammation of the facial nerve causes it to press against the cheekbone or may pinch in the narrow gap. This can result in damage to the protective covering of the nerve.

Any damage to the protective covering of the nerve causes poor transmission of the signals that travel from the brain to the muscles, leading to weakened or paralyzed facial muscles. The exact cause of Bell`s palsy remains unclear.

In some cases, it comes from a virus, usually, the herpes virus inflaming the nerve. This is the same virus that causes genital herpes and cold sores. Other viruses that may cause Bell’s palsy are:

  • cytomegalovirus
  • mumps virus
  • influenza B
  • chickenpox and shingles virus
  • cold sores and genital herpes virus
  • Epstein-Barr virus, or EBV, responsible for mononucleosis
  • hand-foot-and-mouth disease (coxsackievirus)

Risk Factors of Bell`s Palsy

Pregnant women who are in the last trimester have just given birth may be at risk of Bell’s palsy. Migraine sufferers may have a higher risk of Bell’s palsy. This condition commonly affects people who:

  • are between ages 15 and 60 years
  • suffer upper respiratory diseases
  • suffer diabetes
  • are pregnant especially in the third trimester
  • are within a week after they gave birth
  • Note Bell’s palsy affects women and men equally.

Symptoms of Bell`s Palsy

There may be some malfunction in facial nerves controlling the opening and closing of the eyes, smiling, blinking, salivation, lacrimation (production of tears), and frowning. These may happen as a result of such malfunction:

  • drooping in parts of the face, such as one side of the mouth
  • drooling from one side of the mouth
  • difficulty with facial expressions
  • sudden paralysis/weakness in one side of the face
  • difficulty closing one of the eyelids
  • sense of taste may become altered
  • an affected ear may cause sensitivity to sound
  • pain in the front or behind the ear on the affected side
  • headache
  • irritation in the eye as a result of excessive dryness or less blinking
  • changes in the amount of tears the eye produces

How to Treat Bell`s Palsy

lab testMost people recover from Bell’s palsy in about two months, especially those who still have some degree of movement in their facial muscles. Treating it with prednisolone (a hormone) can speed up recovery. Administering prednisolone within 72 hours of onset can reduce symptom severity and the likelihood of repeat after 12 months.


Prednisolone particularly reduces inflammation and accelerates the recovery of the affected nerve. It also prevents the release of substances such as prostaglandins and leukotrienes that may cause inflammation. o treat Bell`s palsy with prednisolone, patients usually take two tablets a day for 10 days. Possible side effects of prednisolone are:

  • difficulty sleeping
  • dry skin
  • headache
  • abdominal pain, bloating
  • acne
  • nausea
  • oral thrush
  • slow wound healing
  • thinning skin
  • tiredness
  • dizziness (spinning sensation)
  • increased appetite
  • increased sweating
  • indigestion
  • mood changes

These side effects normally get better after some days. Patients should report allergic symptoms to prednisolone to their healthcare professional immediately they experience them. The common allergic symptoms are breathing difficulties, hives, and swelling of the face, lips, tongue, or throat. Patients who feel dizzy or drowsy should avoid driving or operating heavy machinery. Because this symptom may not appear immediately after taking prednisolone, it is advisable to wait a day before driving or operating machinery. Doctors usually reduce the dose gradually towards the end of the course of steroid medication. This is to prevent withdrawal symptoms such as tiredness or vomiting.

Eye Lubrication

If the patient doesn`t blink properly, the eye will be exposed and as a result, tears will evaporate. Some patients may experience a reduction in tear production and increase their risk of damage or infection in the eye.

The doctor may prescribe artificial tears in the form of eye drops and an ointment. Patients can take the eye drops during the waking hours, while they are advised to apply the ointment before going to sleep. Patients who cannot properly shut their eyes during sleep may need to use surgical tape to keep it shut.


Some patients may need to take an antiviral alongside prednisolone. This totally dependent on medical observations and a doctor`s prescription.

Home Remedies for Bell`s Palsy

Eat Soft Foods

If the patient has any difficulty swallowing, they may need to chew food well and eat slowly. Eating more soft foods may also be ideal at this time.

OTC Pain Relief

picking up a tabletPain relief medications may be appropriate for some patients. This should be solely based on medical observations and a doctor`s prescription.

Facial Exercises

As the facial nerve gradually recovers, tightening and relaxing facial muscles will help strengthen them.

Dental Care

Food may build up in the mouth, leading to decay or gum disease. Frequent brushing and flossing can help prevent this.

Exercises for Managing Bell`s Palsy

  • Facial workout
  • Wrinkle the nose
  • Breathe in deeply and flare the nostrils
  • Try to move the corners of the mouth outward
  • Pull one side of the mouth up, then the other, to form a smile
  • Sit relaxed in front of a mirror
  • Gently raise the eyebrows; you could use your hands if required
  • Pull the eyebrows together and frown
  • Keep the head still, looking down with your eyes only
  • Place one index finger gently over one eyelid to hold it closed
  • Without using the hands, gently try pressing the eyelids together
  • Hold the eyes half open

How to Diagnose Bell`s Palsy

Diagnosing Bell’s palsy usually requires a process of elimination. The doctor will look for evidence of other conditions that may be causing the facial paralysis, such as Lyme disease, a tumor, or stroke. They may need to check the patient’s head, neck, and ears. They may also assess the facial muscles to ascertain if other nerves are affected, in addition to the facial nerve. If all other causes are excluded, the doctor will diagnose Bell’s palsy.

If the diagnosis is not certain, the patient may be referred to an ear, nose, and throat (ENT) specialist. The specialist will examine the patient and may also ask them to undergo certain tests.