By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

RECOVERY FROM BELL’S PALSY USUALLY RAPID AND COMPLETE

Question: A few weeks ago I was diagnosed with Bell’s palsy. I am recovering nicely, but I am curious about what caused this problem. Is it contagious to my husband and grandchildren? Will I get it again? Will I make a full recovery?

Answer: Bell’s palsy is named after Sir Charles Bell, a Scottish surgeon who studied the 7th cranial nerve and its innervation of the facial muscles 200 years ago. Bell’s palsy is a paralysis of this 7th cranial nerve. Also known as the facial nerve, this paired nerve is the primary motor nerve to the face.

In virtually all cases, Bell’s palsy only affects the nerve on one side of the face and causes the muscles to become temporarily paralyzed. Other symptoms may include pain in the area of the nerve, tearing (because you are unable to close your eye), drooling (because you can’t close your mouth on the affected side) and a change in sense of taste. For most people, Bell’s palsy is more of a short-term nuisance than a long-term medical problem.

The onset of Bell’s palsy, or facial nerve paralysis, is as a result of trauma to the facial nerve. Generally, when we think of trauma, we think of being hit or injured in some way. But trauma can also be the result of an infection. In some cases of Bell’s palsy, researchers have speculated that a viral infection might have caused the trauma. This speculation has centered on the cold sore virus, herpes simplex and other herpes viruses.

As you can see, we don’t know exactly what causes Bell’s palsy; however, we do know some things about who is more at risk. While it can strike almost anyone at any age, it disproportionately attacks pregnant women and people who have diabetes, influenza, a cold or some other upper respiratory ailment.

The disease usually comes on very quickly. Most people either wake up to find they have Bell’s palsy, or have symptoms -- such as a dry eye or tingling around their lips -- that progress to classic Bell's palsy during that same day. Occasionally, it may take a few days for symptoms to become recognizable as Bell’s palsy. A warning sign may be neck pain or pain in or behind the ear, but it is not usually recognized in first-time cases.

Bell’s palsy is usually diagnosed by the patient reporting the symptoms I’ve described with this type of relatively rapid onset. The doctor then conducts what’s called a “diagnosis of exclusion” by ruling out other possible disorders. To accomplish this, he or she will check to see that no other body parts are affected and that laboratory tests and X-rays are normal.

The good news is that the majority of Bell’s sufferers make a full recovery in a few weeks, and another 30 percent within three months. Recent studies have shown that treatment with steroids and antiviral drugs are proving to be highly effective. Using medication to prevent the affected eye from drying out, because it cannot close, is also very important.

Bell’s palsy is not contagious. After getting started on medications and after any other accompanying illnesses have passed, a person can resume normal activities. As for recurrences, yes they are known to occur. The recurrence rate varies widely between 5 and 9 percent. The time between recurrences is about 10 years.

[Editor’s note: The information in the standard block below has changed. Please use this instead of the old information.]

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.