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Bell's Palsy

Bell's palsy is sudden weakness or paralysis on one side of the face caused by inflammation of the facial nerve; most people recover fully, especially with prompt steroid treatment.

Neurologic
Bell's palsy is a sudden weakness or paralysis of the muscles on one side of the face, caused by inflammation of the facial nerve. It can affect anyone at any age and is understandably frightening — a drooping face is also a sign of stroke — but Bell's palsy itself is usually temporary. Most people begin improving within a few weeks, and the majority recover completely, especially when treatment starts promptly. Causes and Risk Factors: The facial nerve travels through a narrow bony canal on its way to the face; when it becomes inflamed and swollen, its signals are blocked:
  • Viral reactivation: Bell's palsy is believed to be triggered most often by reactivation of common viruses, particularly the herpes simplex virus that causes cold sores.
  • Diabetes: People with diabetes have a higher risk of Bell's palsy.
  • Pregnancy: Risk rises in the third trimester and just after delivery.
  • Recent illness: An upper respiratory infection often precedes the facial weakness.
Symptoms: Symptoms develop rapidly, usually over hours to three days, and involve one side of the face:
  • Facial drooping: A flattened smile, sagging eyebrow, and inability to fully close the eye on the affected side — including the forehead, which is an important clue.
  • Eating and speaking changes: Drooling, food catching in the cheek, or slightly slurred words from weak facial muscles.
  • Eye symptoms: Dryness or excessive tearing because blinking is impaired.
  • Altered taste: Reduced or changed taste on the front of the tongue.
  • Ear discomfort: Pain around the jaw or behind the ear, and unusual sensitivity to sound on that side.
When to Seek Immediate Care: Sudden facial drooping should be treated as an emergency until stroke is excluded. Call 911 right away if facial weakness comes with arm or leg weakness, numbness, trouble speaking or understanding, vision loss, severe headache, or dizziness. A stroke typically spares the forehead muscles, but this distinction is for clinicians to make — never try to diagnose yourself at home. Diagnosis: Bell's palsy is diagnosed by examination after other causes are excluded. Your physician will confirm that the weakness involves the whole side of the face, look for rashes or blisters that suggest shingles of the ear, consider Lyme disease when exposure is possible, and check blood sugar. Imaging or nerve testing is reserved for atypical cases — weakness that comes on slowly, affects both sides, or fails to improve as expected. Treatment: Early treatment improves the odds of full recovery:
  • Corticosteroids: A course of prednisone, ideally started within 72 hours of onset, reduces nerve swelling and clearly improves recovery.
  • Antiviral medication: Valacyclovir is sometimes added to steroids, particularly in severe cases.
  • Eye protection: Because the eyelid cannot close fully, lubricating drops during the day, ointment at night, and taping or a patch during sleep protect the cornea — this is essential to prevent lasting eye damage.
  • Facial exercises and time: Gentle facial movement practice supports recovery as nerve function returns over weeks to months.
Complications: Most people recover completely within a few weeks to a few months, but a minority are left with lasting effects:
  • Incomplete recovery: Some facial weakness can persist, most often when the initial paralysis was complete and improvement was slow to begin.
  • Corneal injury: An eye that cannot close fully may dry out, become scratched, or develop an infection — the reason eye protection is emphasized from the first day.
  • Synkinesis: As nerve fibers regrow they can reach the wrong muscles, so the eye may narrow when you smile or the corner of the mouth may twitch when you blink.
  • Tearing while eating: Misdirected regrowth can also send signals to the tear gland, causing the eye to water during meals.
Most people with Bell's palsy recover fully, but early evaluation matters both for treatment and to rule out more serious causes. The internal-medicine team at Zimmer Medical Group can guide you through diagnosis, treatment, and follow-up — schedule a visit without delay if you notice facial weakness.

Related Medications

Commonly prescribed medications for this condition

PrednisoneValacyclovir

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