It is a weakness or paralysis of
the muscles of one side of the face. The face droops on that
side and there is inability to close the eye on the affected
side. The problem is with the nerve that controls the
muscles on that side of the face, rather than due to any
pressure.
How does it occur?
The exact cause of Bell's palsy is not known.
It is believed to be caused due to a viral infection of the
facial nerve. This infection causes the nerve to swell and
press against the bony canal through which it passes into
the face. This leads to a failure in the transmission of
signals to the facial muscles thus causing paralysis.
What are the symptoms?
It usually starts with an ache
behind one of the ears followed by weakness or paralysis in
the facial muscles on the same side. The paralysis or
weakness generally starts in the lower face. There may be a
decrease in taste, a change in hearing, tears in the eye and
the inability to whistle or hold food in the mouth. The
severity can vary from a mild weakness to complete
paralysis. The severity of the illness is directly
proportional to the speed of progression of the symptoms.
The development of symptoms can take as little as a few
hours (sometimes overnight) to a couple of days.
How is it diagnosed?
The doctor will review the symptoms and
conduct an examination. Other causes of facial paralysis
have to be excluded. The causes of facial paralysis other
than Bell's palsy include an injury to the nerve (skull
fracture), stroke, acute or chronic ear infection, tumour in
the ear or in the parotid (salivary gland in front of the
ear), and a viral illness such as shingles.
An ear, nose, throat, and a neurological exam will exclude
most of the other causes of facial paralysis. A hearing test
is done to check for an inner ear tumour. A CT scan of the
head may be done to rule out a tumour in the ear or brain.
Electrical testing on the nerve may be required to know the
extent of damage.
What is the treatment?
A short oral course of steroids,
if started early enough, can speed up recovery, even though
most people recover completely even without treatment. It is
very important to protect the eye on the affected side from
dust and drying by either patching the eye or using
artificial tears. In the few cases where recovery is very
slow or not very imminent, various plastic surgical
procedures can improve the cosmetic appearance of the face.
How long will the effects last?
The degree of weakness is
important to predict whether nerve function will return
completely or not though 80% of people recover completely.
Patients with no movement of the facial muscles at all
generally have less than full return of muscle movement.
Mild cases with at least some muscle movement can usually
expect a complete recovery.
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