Having a baby is undoubtedly a magical experience for every mother. But for Celine, the story was different. Only hours after she was discharged from the hospital, she started noticing a loss of taste on the right side of her mouth. She started feeling a bit numb too but was able to feel her tongue.
Panicked, she searched the entire internet but couldn’t find a single reason for her condition. The next morning, as she woke up to feed her little one, Celine realized that she was no longer able to talk properly. She tried smiling but it seemed like the right side of her face had just been frozen.
Her husband rushed her to a hospital where she remained for hours until a final diagnosis was made: Bell’s palsy.
Just like Celine, Bell’s palsy can be a scary situation for many people out there. The sudden inability to smile, frown, blink, or use one side of your face to perform anything would upset anyone. Let's look at what this condition is, why it develops, and how can it go away.
What is Bell’s Palsy?
Bell’s palsy refers to paralysis or weakness on either side of the face. The symptoms usually appear in the morning as the person wakes up from sleep. The first signs are usually an inability to control facial muscles on one side. This is followed by the drooping of the face on the affected side. In some cases, tear and saliva production is altered and the sense of taste is also lost. (1)
Most symptoms of Bell’s palsy closely resemble that of a stroke. However, strokes tends to be more generalized with weakness extending to the arms and legs of the affected side whereas Bell’s palsy remains limited to the face.
According to a survey, 1 in every 5000 people develops this condition every year. (2) Because it is a relatively rare problem, most people are not aware of it which may lead to unnecessary panic.
What Causes Bell’s Palsy?
The facial nerve is the chief nerve that controls the movement of most facial muscles in addition to a few parts of the ear. This nerve enters the facial area from the brain through a narrow gap in the bone. Sometimes, when this nerve gets inflamed, it may increase in size and press against the bone, leading to pinching. This pinching damages the protective covering of the facial nerve and as a result, the signals traveling from the brain to the facial muscles may get hindered leading to paralysis.
The exact reason why inflammation and pinching of the facial nerve occurs is not known. However, scientists have recently concluded that the inflammation might be caused by a handful of viruses. Some of these viruses include:
- Varicella Zoster virus
- Shingles virus
- Cytomegalovirus
- Viruses responsible for herpes and cold sores (3)
- Epstein-Barr virus
- Coxsackievirus
- Influenza B virus
What Are The Symptoms Of Bell's Palsy?
Bell’s palsy is usually characterized by the following symptoms: (4)
- Inability to move facial muscles
- Increased sensitivity to sound
- Loss of facial expressions including blinking, squinting, closing eyelid, or smiling
- Drooling of saliva on the affected side
- Excessive tearing on the affected side
- Headache
- Numbness of the face
- Loss of the sense of taste on the affected side
Who Is At Risk Of Developing Bell’s Palsy?
Bell’s palsy is commonly associated with several medical conditions such as:
- High blood pressure
- Exposure to toxins
- Guillain-Barre syndrome
- Injury
- Diabetes (5)
- Multiple sclerosis
- Lyme’s disease
- Myasthenia gravis
- Infection
- Pregnancy (6)
Strong associations have been found between migraine and facial weakness as well. (7) The condition is more prevalent in people between 15 to 60 years of age. Both genders are equally susceptible to developing it.
Diagnosing Bell’s Palsy
In most cases, Bell’s palsy can easily be diagnosed on clinical grounds by just conducting a physical exam of the symptoms. No specific tests are available to diagnose it. However, sometimes it is imperative to rule out other conditions that may cause similar symptoms. Tests may also be needed to check the extent of nerve damage.
Some of these tests may include:
- Blood tests to check if the person suffers from a pre-existing condition like Lyme’s disease or diabetes
- Electromyography to check the extent to which facial nerve is involved in the attack
- Computed tomography (CT scan) or Magnetic resonance imaging (MRI) to rule out any structural cause behind the symptoms
In most cases, the main aim of the physician is to rule out any underlying tumor or a stroke that might induce similar symptoms.
Bell’s Palsy Treatment
In more than 80 percent of the people, Bell’s palsy along with all of its symptoms tend to go away on its own. The recovery process can be expected to begin in three weeks from the onset of the problem and may take two or three months for complete resolution.
The other 20 percent of cases do not undergo spontaneous resolution and after checking individual cases and circumstances, the doctor can take one of the many routes to treat Bell’s palsy.
Some common Bell’s palsy treatment modalities offered are mentioned below.
Prednisolone
Prednisolone is a type of steroid that targets inflammation in different parts of the body and tends to reduce it. When administered in a patient with Bell’s palsy, it directly works to soothe the inflamed facial nerve to relieve symptoms. The mechanism of action of prednisolone involves inhibition of the release of pro-inflammatory substances in the body, such as leukotrienes and prostaglandins. (8)
Research has found that administering prednisolone in patients within 72 hours of the onset of Bell’s palsy symptoms can greatly decrease the severity of its symptoms and chances of reoccurrence. Prednisolone is usually directed to be taken by mouth. Two tablets are prescribed per day for a total of 10 days.
Keep in mind that daily consumption of prednisolone may lead to certain side effects which may include:
- Abdominal pain
- Dryness of skin
- Mood changes
- Indigestion
- Headache
- A spinning sensation
- Sleep-related difficulties
- Bloating
- Acne
- Increased appetite
- Excessive sweating
- Oral thrush
- Nausea
- Thinning of skin
- Slower wound healing
- Increased fatigue
None of the side effects are life-threatening and most of them go away on their own in a few days. In very rare cases, some people may develop an allergic reaction to prednisolone. The symptoms of such an attack include:
- Difficulty in breathing
- Hives
- Swelling of the lips, throat, face, and tongue
Prednisolone may make you drowsy or dizzy and in such circumstances, you must avoid operating heavy machinery and driving. The dose of prednisolone is usually tapered off by the doctor in order to prevent withdrawal symptoms.
Eye Lubrication
Sometimes, Bell’s palsy can hinder eye blinking on the affected side causing tears to evaporate. In some patients, there might be a decrease in tear production. Both of these conditions can be harmful to the eyes and may lead to damage or infection.
To prevent any eye damage, artificial tears might be provided by the doctor in the form of ointment or eye drops. The ointment is usually applied just before going to sleep whereas the drops can be used during the day.
Some patients are unable to close the eye on their affected side, even during sleep. To overcome this problem, they may need to keep their eye shut using a piece of surgical tape or an eye patch. (9) If any worsening of symptoms occur, you must get to the nearest hospital and seek help from a suitable doctor.
Antivirals
Because certain cases of Bell’s palsy are caused by viruses, taking a suitable antiviral may also alleviate the symptoms.
At-Home Care
The doctor may also describe different ways to take care of yourself at home during an attack of Bell’s palsy. This at-home care package may include:
Facial exercises: These facial exercises can relax the facial muscles and increase their strength.
Dental care: With little to no feeling in the mouth, it might be possible to develop dental problems due to food accumulations in the mouth. Therefore, proper dental care including regular flossing and brushing might be prescribed.
Pain relief: An over-the-counter painkiller might be prescribed by the doctor to overcome any discomfort.
Bell’s Palsy Outlook
Most patients suffering from Bell’s palsy undergo complete resolution of their symptoms in 9 months from the onset of the problem. A few of them may experience extended nerve damage and require an extension of treatment, depending on their circumstances.
This extensive treatment regimen may include:
Mime Therapy
Mime therapy is a form of physical therapy that is taught to the patients for strengthening the muscles of their face. Performing this therapy regularly improves the coordination of facial muscles and widens their range of motion.
Plastic Surgery
Sometimes, plastic surgery is suggested for patients who have lost the symmetry and appearance of their faces to a great extent. With a few necessary surgical steps, such patients can smile again, even though the nerve damage is not completely cured.
Botox
Botox injections are often recommended to loosen the tight facial muscles and get rid of all unwanted contractions of these muscles.
The Endnote
Bell’s palsy is a rather uncommon condition in which half of the face suddenly stops working. Though it may sound alarming, most cases are risk-free and usually resolve on their own. For the very few that require treatment, multiple routes of management are available to try according to individual circumstances.
