Sudden Facial Droop and Bell's Palsy: Why It Needs a Same-Day Check

What it involves

MedlinePlus explains that Bell palsy is a disorder of the facial nerve, the seventh cranial nerve, which controls the muscles of the face. Damage to the nerve causes weakness or paralysis on one side of the face. It is thought to come from swelling of the nerve where it travels through the bones of the skull, and the cause is often not clear.

Who this is for

• Adults whose face became weak or drooped on one side over hours or a few days
• People who cannot fully close one eye or whose smile has turned lopsided
• Patients with diabetes, which MedlinePlus says may increase the risk
• Anyone who had a cold or ear infection recently and now has pain or stiffness behind the ear

What to expect

• Questions about when the weakness began, whether it came with arm or leg weakness, speech trouble or confusion, and any recent illness
• An exam of the face, eyes, ears and nervous system, including how well you can close your eyes and smile
• Blood work if another cause, such as Lyme disease, is possible
• A referral for imaging or a neurologist when the cause is not clear

Telling Bell's palsy from a stroke

Both can make one side of the face droop, and they cannot be told apart at home. MedlinePlus says to contact your provider right away if your face droops or you have other symptoms of Bell palsy, so that more serious conditions such as a stroke can be checked for. Sudden weakness in an arm or leg, trouble speaking or understanding speech, vision trouble and a sudden severe headache are stroke signs that mean calling 911, and the stroke warning signs guide lists them in full.

What it feels like

Symptoms usually start suddenly and may take two to three days to fully develop, after which they do not get worse. They are almost always on one side of the face and range from mild to severe. Many people feel discomfort behind the ear before the weakness shows. The face may feel stiff or pulled to one side, with difficulty closing one eye, food falling from the corner of the mouth, drooling, slurred words from lip weakness, trouble smiling and twitching. Some people also have dry eye, dry mouth, a change in taste or sound that seems louder in one ear.

Who gets it and why

Bell palsy most commonly affects people 15 to 45 but can occur at any age, and males and females are equally affected. The cause is often unclear, though a herpes simplex or herpes zoster infection may be involved. Other conditions that can affect the nerve include HIV, Lyme disease, middle ear infection and sarcoidosis, and diabetes and pregnancy may raise the risk. The shingles guide, the ear infection guide and the tick bites and Lyme disease guide describe three of those.

How it is checked

Often, MedlinePlus says, Bell palsy can be diagnosed from a health history and a complete physical exam. Blood tests may look for conditions such as Lyme disease that cause similar symptoms. Tests of the nerves and muscles, called EMG and nerve conduction studies, are sometimes used, and if your provider is worried about another cause they may suggest a head CT, an MRI or a lumbar puncture. Imaging and nerve testing are arranged by referral, while blood work can be drawn through the practice.

Treatment and the first days

Often no treatment is needed, and symptoms often begin to improve right away, although the muscles can take weeks or months to get stronger. Medicines may improve the chances of recovery but must be started right away. Common choices are corticosteroids to reduce swelling and an antiviral such as valacyclovir. Lubricating eye drops or ointment protect an eye that cannot close fully, and an eye patch may be worn during sleep. Surgery to relieve pressure on the nerve has not been shown to benefit most people. The timing is the reason to call the day it starts.

Recovery and what to watch

Most cases go away completely within a few weeks to months. If you did not lose all nerve function and symptoms began to improve within three weeks, MedlinePlus says you are more likely to regain most or all of the strength in your facial muscles. Some people have lasting taste changes, muscle or eyelid spasms or weakness. The main complication is a dry cornea that can lead to eye sores, infections and vision loss, which is why eye protection matters. There is no known way to prevent Bell palsy. A drooping eyelid and facial weakness that worsen through the day and improve with rest fit a different pattern, which the myasthenia gravis guide describes along with when to call 911. Sharp, electric-like pain on one side of the face without weakness or droop is a different problem, and the trigeminal neuralgia guide explains its triggers and how it is worked up.

Sources

• MedlinePlus: Bell palsy (medical encyclopedia)
• MedlinePlus: Bell's Palsy (health topic)