Most
patients feel extreme distress when they experience the symptoms of Bell’s
palsy. Over a couple of hours or a couple of days, the facial muscles on
one side become progressively weaker and that side of the face begins to
droop. The initial sign may be an ache behind the ear on the affected side
and an exaggerated sensitivity to sound. By the time, Bell’s palsy
has taken its course, the person may be unable to perform simple functions
such as smiling, frowning or blinking an eye.
Craig thought he was having a stroke and went to the emergency room–a
wise move because a stroke often presents with similar symptoms.
Actually, a doctor diagnoses Bell’s palsy by ruling out other causes
of partial facial paralysis, such as a stroke, multiple sclerosis, a tumor
of the inner or middle ear, a skull fracture, an ear infection or shingles.
Most of these illnesses have additional symptoms and more severe consequences
so prompt medical attention is crucial.
Bell’s palsy affects only one side of the face and, unlike stroke,
does not include central nervous system symptoms such as weakness or lack
of coordination in other parts of the body. Even though a stroke is far
more threatening, Bell’s palsy usually has a more exaggerated paralysis
on the affected side of the face–to the extent that the patient is
typically unable to wrinkle her forehead.
A diagnosis of Bell’s palsy may actually be greeted with relief because
in most cases the partial facial paralysis will resolve itself in a few
weeks.
Bell’s palsy affects roughly 50,000 Americans each year, with the
greatest prevalence among persons 15 to 44 years of age.
Pregnant Women at Risk
Sir Charles Bell, the Scottish surgeon who identified the disorder in
1830, observed that it was more prevalent among pregnant women. Subsequent
studies have confirmed that pregnant women are three times more likely
than non-pregnant women to get Bell’s palsy, and the risk is greatest
during the third trimester or immediately following childbirth. Persons
with diabetes, hypertension, the flu or a cold also seem to have a higher
than average vulnerability. Overall, however, prevalence is about the
same among men and women, and the paralysis occurs equally often on both
sides of the face.
Loss of control over facial muscles occurs when the facial nerve becomes
swollen and then compressed by the bony canal through which it passes
so that it can no longer transmit impulses from the brain to the facial
muscles.
The reason for the sudden swelling is unknown. At one time, doctors believed
it was associated with fluid retention or hypertension–both of which
are common among pregnant women. Other theories link the swelling to a
viral infection or inflammation. Recent evidence suggests it may be associated
with the herpes simplex virus (HSV), which also causes cold sores and
fever blisters. One recent study found the DNA of herpes simplex virus
in endoneurial fluid taken from the facial nerve of 80 percent of persons
with Bell’s palsy but in none of the subjects with other types of
facial paralysis.
Although not life threatening, Bell’s palsy can create substantial
suffering. When the eye on the affected side does not close, it must be
protected against dust, debris and excessive dryness. Eye lubricants,
ointments and artificial tears are sometimes recommended along with an
eye patch or protective tape at night.
Among persons suffering only partial paralysis, 90 percent recover full
function of facial muscles within three to six weeks, and most of the
rest recover by the end of six months.
In the meantime, most patients are unable to talk, eat or smile normally
and may lose taste sensations on one side. The dramatic change of facial
appearance leads many to curtail social activities and become isolated.
Persons who suffer full paralysis don’t fare as well. A little over
half recover full function of their facial muscles and another 20 to 30
percent get partial recovery, often with some involuntary facial movements
persisting indefinitely.
About 10 to 20 percent never get better. For them, the only options involve
plastic surgery, although physical therapy may be helpful in retraining
facial muscles and providing social support.
What Can Be Done?
At this time, there is nothing that can be done to prevent Bell’s
palsy, and there is no treatment that has been proven effective.
Most doctors prescribe a steroid such as prednisone and sometimes an antiviral
medication such as acyclovir in an effort to quickly reduce the swelling
of the facial nerve.
A recent review of randomized controlled trials found no strong evidence
that steroids provided any long-term benefit, although one study indicated
some effectiveness from the combination of acyclovir and prednisone.
These medications are generally safe although pregnant women are advised
to avoid steroids.
Surgery has been used in the past in an effort to relieve compression
of the facial nerve. It’s rarely performed today except for severe
cases since the procedure carries a risk of damaging other nerves while
offering no guarantee of recovery.
In most cases, treatment consists of watchful waiting, with frequent examinations
to track recovery. Generally, the sooner recovery begins, the less risk
there is of residual after effects. And usually, improvement begins within
two to three weeks.
For persons who don’t recover after Bell’s palsy, there are
several plastic surgery options that may partially restore muscle function
and improve appearance. Another nerve, such as the one that serves the
tongue, can be surgically attached to the facial nerve; muscle tissue
can be transferred from another part of the body such as the lips; and
weights or springs can be attached to the eyelids to help the person open
and close the affected eye.
All of these involve some trade-offs and are rarely performed until Bell’s
palsy has persisted for at least 6 to 12 months with no sign of improvement.
For patients experiencing partial muscle weakness following Bell’s
palsy, one survey found that 30 percent felt these symptoms had little
or no effect on their social interaction. Another 45 percent reported
a slight effect. The others felt more profound consequences, including
social anxiety and loss of employment.
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