From the Guidelines
Bell's palsy symptoms include sudden weakness or paralysis on one side of the face, making it appear droopy or stiff, and patients typically experience difficulty closing the eye on the affected side, drooling, decreased ability to taste, facial pain or discomfort, increased sensitivity to sound, headache, and changes in tear or saliva production. The onset is usually rapid, developing over 24-72 hours, as noted in the clinical practice guideline: Bell's palsy executive summary 1. Many patients report having a cold or ear infection before symptoms appear. The condition results from inflammation of the facial nerve (cranial nerve VII), which controls facial muscles, causing the nerve to swell within the narrow facial canal, leading to compression and temporary dysfunction, as explained in the clinical practice guideline: Bell's palsy 1. Some key symptoms and signs of Bell's palsy include:
- Dryness of the eye or mouth
- Taste disturbance or loss
- Hyperacusis
- Sagging of the eyelid or corner of the mouth
- Ipsilateral pain around the ear or face Most cases resolve on their own within 3-6 months, though some patients may benefit from a short course of oral corticosteroids like prednisone, as supported by high-quality randomized controlled trials, such as the study by Sullivan et al 1. The use of oral steroids within 72 hours of symptom onset is strongly recommended for Bell’s palsy patients 16 years and older, based on high-quality randomized controlled trials with a preponderance of benefit over harm 1. Eye protection with artificial tears and lubricating ointment is crucial if the eye cannot close properly to prevent corneal damage, as recommended in the clinical practice guideline: Bell's palsy 1.
From the Research
Symptoms of Bell's Palsy
The symptoms of Bell's palsy include:
- Unilateral facial weakness or paralysis, which can result in the inability to close the eyelids, smile, or whistle 2
- Acute onset of unilateral, lower motor neuron weakness of the facial nerve in the absence of an identifiable cause 3
- Muscle weakness on one side of the face, with forehead involvement and no other neurologic abnormalities 4
- Unilateral facial paralysis over one to three days, with symptoms typically peaking in the first week and then gradually resolving over three weeks to three months 4
- Mild pain, numbness, increased sensitivity to sound, and altered taste 5
- Incomplete eyelid closure with resultant dry eye, which is a common short-term complication of Bell's palsy 4
Characteristics of Bell's Palsy
Bell's palsy is characterized by:
- A peripheral palsy of the facial nerve that results in muscle weakness on one side of the face 4
- An idiopathic condition, although it is believed to be caused by inflammation of the facial nerve at the geniculate ganglion, and may be triggered by reactivation of herpes viruses from cranial nerve ganglia 2, 5
- A condition that can affect persons of any age, but is most common in people aged 15-40 years, and affects 1 in 60 in their lifetime 5
- A condition that can have a significant impact on patients and their relatives, causing physical and psychological complications 6