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The Informed Parent

Bell’s Palsy

by Peter W. Welty, M.D., F.A.A.P.
Published on Jul. 14, 2003

Ginny appeared in the office with intensely disturbed parents. It seems that quite suddenly the left side of her face became paralyzed. It was as though this all happened overnight. The parents were frantic to have an explanation.

Bell's palsy is an acute one-sided weakening or paralysis of the face. It is a peripheral nerve dysfunction; a condition which is without known causes. Additional symptoms of Bell’s palsy may include pain in or behind the ear on the affected side. It may present with numbness in the affected side of the face, increased hearing or hyperacusis, or disturbed taste on the front part of the affected side of the tongue.

Approximately 23 out of 100,000 people a year acquire Bell’s palsy. Males and females are affected equally. There is a peak incidence between ages 10-to-40 years. It happens equally on the right or the left side of the face.

The causes of Bell’s palsy are unclear. Some researchers have looked to viral infection, vascular disorders, autoimmune inflammatory disorders or heredity as possible sources. A viral cause has been suggested, as some researchers have discovered a genetic piece of the herpes simplex -1 virus in the endoneurial fluid of those patients with the condition.

More than two-thirds of the people who are affected with Bell’s palsy have spontaneous recovery. 85% of those achieve improvement within three weeks of the onset. For the other 15% some improvement occurs in three-to-six months. Of those who recover, 71% achieve normal functioning of the face, 13% have insignificant remaining symptoms, and 16% have permanently diminished functioning of the nerves in the affected side of the face.

Some of the treatments for Bell’s palsy include corticosteroids. These medicines decrease the inflammation of the nerves on the affected side of the face. Steroids significantly improve the recovery of facial nerve function. Some other treatments also include the addition of acyclovir, an anti-viral medicine, in combination with corticosteroids. Patients who receive the combination of steroids and acyclovir achieve significantly higher rates of recovery and restored function than patients who receive prednisone alone.

The goals for people affected with Bell’s palsy are to maximize the recovery of facial function on the affected side of the face, to minimize complications and adverse affects.

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