FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

VICTIMS OF BELL'S PALSY USUALLY RECOVER COMPLETELY

Question: My husband awoke with the right side of his face paralyzed. We hurried to the emergency room because we were afraid of a stroke. The doctor diagnosed the problem as Bell's palsy, instead, and told us to see our family doctor. We did, but I still don't understand the cause of my husband's condition. What is Bell's palsy? Will he recover?

Answer: Bell's palsy is a relatively common abnormality of the nervous system afflicting 25 out of every 100,000 people. It is a problem with the nerve, specifically the VII cranial nerve, that controls muscles of the face. This nerve is actually a paired structure, with one nerve going to the left side and the other to the right. In Bell's palsy one side quits working relatively suddenly. For this to occur overnight, as in your husband's case, is fairly typical.

A "palsy" is a paralysis of muscles. In Bell's palsy, one of the facial nerves can no longer send the necessary signals to properly control the muscles to which it is connected. This results in symptoms characteristic of the disorder the involved side of the face is relaxed and doesn't move when the person talks, eats and makes normal facial expressions. The forehead doesn't wrinkle with looking up, and the eyelid droops and doesn't move with eye movement. At first glance one would wonder if the afflicted person was winking at you.

Other changes may occur on the involved side. Occasionally, there is pain behind the ear or a subtle change in the way the affected facial skin feels. The sense of taste, on the involved side of the tongue only, may be absent or distorted. There may also be marked sensitivity to sound. But the symptom that is always present, the dominant feature of Bell's palsy, is the inability to use the muscles of facial expression.

A general explanation for the cause of Bell's palsy is that there is inflammation of the facial nerve, and this inflammation keeps it from working properly. Some experts have made educated guesses that the inflammation results from a viral infection. This makes some sense since about one-half of afflicted individuals report having had a "cold-like" illness just prior to the onset of the palsy. However, it's hard to explain by this theory why the other half don't report having had a cold. Other doctors postulate that Bell's palsy is an immune reaction. My personal conclusion is that researchers haven't yet figured out the cause.

Fortunately, 85 percent of individuals with Bell's palsy recover totally within one year. Many do so within six weeks. Those who have additional symptoms or who don't get better should be seen by a neurologist, a physician specializing in the disorders of the nervous system. Infrequently, infections, tumors and other conditions may produce symptoms that are the same as those of Bell's palsy. Their treatment, however, is considerably different.

I think your husband's prognosis is probably excellent. In other words, based on what you've told me about the onset of your husband's condition and his doctor's diagnosis, his prospects for a complete recovery should be very good.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.