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Bell's palsy
A DISCUSSION OF BELL'S PALSY
This document reviews our present understanding of Bell's palsy and its various treatments.
CURRENT CONCEPTS
- It is important that a thorough examination, including hearing tests and sometimes a MRI, be done to determine the cause of the facial paralysis.
- Bell's palsy is the result of a viral infection of the facial nerve as it travels from the brain, through the ear and then out into the muscles of expression on the face. The viral infection causes the nerve to swell within the narrow channel of bone where it courses. This compression of the facial nerve results in a partial or complete paralysis of the facial muscles. Bell's palsy is not the result of a stroke or brain tumor.
- Antibiotics, such as penicillin, are not helpful because the infection is not a bacterial infection. Preliminary research with certain antiviral drugs, such as acyclovir (also called Zovirax or Famvir) indicates that these medicines may be helpful in eradicating the viral infection. Acyclovir 200 mg. is taken every 4 hours by mouth, except for the middle of the night dose, for 2 weeks. It can sometimes cause stomach upset, especially when taken on an empty stomach, but is generally well tolerated and has no serious side effects.
- Cortisone drugs, such as prednisone, are sometimes used to reduce the inflammation in the facial nerve.
- Bell's palsy is not contagious.
- Bell's palsy is not uncommon. Approximately 100 cases occur in Sacramento County each year.
- All patients recover some function of the face. Approximately 85% of patients will have a complete recovery, usually within 3 months. After the first 2 weeks of Bell's palsy there are no treatments that significantly improve the outcome.
Unfortunately, 15% of patients will not recover completely. Often these patients have a delay in recovery for up to 12 months. Electrical stimulation tests done in the office will usually identify these patients. These patients usually have mild to moderate degrees of facial weakness permanently.
As a result of the occasional patient with a poor outcome, an operation called middle fossa facial nerve decompression is rarely performed. Current research demonstrates that this operation is only marginally effective. The risks of the operation are so significant when weighed against its effectiveness that the vast majority of Bell's palsy patients never undergo this operation.
EVALUATION
- Examination of the ear, face and nerves.
- Hearing tests to determine if the hearing is affected (it is commonly effected by a tumor but not with
Bell's palsy).
- Tearing tests if the cornea of the eye becomes exposed.
- Blood tests are sometimes necessary to exclude rare causes of facial paralysis, such as Lyme's Disease and certain blood disorders.
- Follow-up visit in 1 month and until the paralysis resolves.
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