Bell’s Palsy – Diagnosis and Treatment
Diagnosis
Doctors diagnose Bell’s palsy by checking the face and reviewing symptoms. They often ask the person to perform facial movements, such as raising eyebrows, showing teeth, closing eyes tightly, or frowning.
These actions help doctors see if the weakness affects only one side and how severe it is. They also consider other possible causes of facial nerve paralysis, including stroke, Lyme disease, tumors, diabetes, Ramsay Hunt syndrome, and certain viral infections.
Doctors use medical history and a careful exam to look for signs that suggest other conditions. When necessary, they may order extra tests.
- Electromyography (EMG): This test checks for nerve damage and measures how well the facial nerve works.
- Imaging Tests (MRI, CT): Doctors use these to rule out tumors, trauma, or other problems pressing on the 7th cranial nerve.
- Blood Tests: These tests help rule out infections such as Lyme disease or immune disorders.
Below is a simple table showing which tests doctors may use:
| Test Type | Purpose |
|---|---|
| EMG | Measures nerve function and muscle response |
| MRI or CT scan | Checks for tumors, strokes, fractures |
| Blood tests | Looks for infections (Lyme, viral causes, etc.) |
Doctors look for signs like facial weakness, drooping, pain near the ear, drooling, loss of taste, or the inability to close the eyelid. Quick diagnosis helps ensure the paralysis is not due to more serious conditions.
Treatment
Medications to Help Healing
Doctors usually prescribe oral corticosteroids. These steroids reduce swelling around the facial nerve and can speed up recovery.
Starting steroids within three days of symptoms works best. Patients who take steroids early are more likely to recover fully.
| Medication Type | Purpose | When Used |
|---|---|---|
| Steroids | Reduce swelling, speed recovery | Start within 3 days of symptoms |
| Antivirals | Fight viral infections | Sometimes with steroids |
Sometimes, doctors add antiviral medications. These drugs target viruses that might contribute to Bellโs palsy, but antivirals alone have not shown strong benefits.
Doctors often use antivirals together with steroids in severe cases, though experts continue to debate their overall usefulness.
Exercises and Therapies for Facial Muscles
Physical therapists recommend facial exercises to keep muscles active. If not used, these muscles can weaken, shrink, or stiffen.
A physical therapist can design exercises and massages for each person. These activities may help prevent long-term problems and support full recovery.
- Massage and gentle exercises keep muscles flexible.
- Regular stretching lowers the risk of tightness.
Therapy may also help with issues like “crocodile tears,” where the eye waters during eating.
Surgical Options for Complex Cases
Doctors rarely choose surgery first for Bell’s palsy. In the past, surgeons performed decompression surgery to ease nerve pressure, but this is no longer recommended because of risks like hearing loss or nerve damage.
If recovery is incomplete, doctors may consider plastic surgeries or facial nerve repair. Procedures like eyebrow lifts, eyelid lifts, or nerve grafts can restore facial balance and improve movement.
Some surgical options may need repeating after a few years. These treatments aim to manage long-term complications when other therapies are not enough.
Everyday Care and Home Tips
People can use over-the-counter pain relievers like acetaminophen or ibuprofen for mild pain. Gentle facial massage and simple exercises, as recommended by a healthcare provider, help keep facial muscles relaxed and may reduce weakness.
For dry eyes, use artificial tears and wear an eye patch at night to protect and moisten the eye. These steps help prevent unwanted facial movement, eye damage, or trouble with facial expression.
Other Treatment Approaches
Some people try options beyond standard medical care for Bell’s palsy. The following methods have limited proven benefits:
- Acupuncture: Thin needles are inserted at specific points to stimulate nerves and muscles, sometimes providing relief.
- Biofeedback: This training teaches people to control their muscles through mental focus, which may help facial movement.
- Botulinum Toxin: Injections can reduce muscle spasms and unwanted tearing, helping restore facial balance.
Currently, these options lack strong scientific support, but some people find them helpful as part of their care.
Getting Ready for Your Visit
Steps You Can Take Beforehand
You can prepare for your medical visit to get better care. Here are some actions to take:
- List all current symptoms. Describe every symptom, even those you think are not related.
- Note important personal details. Write down any recent stresses or big life changes.
- Prepare a medicine list. Include all medications, vitamins, and supplements, with dosages.
- Ask a friend or family member to go with you. Another person can help remember details or ask questions.
- Write down your questions. This helps you remember what to ask. Some helpful questions include:
| Questions for Your Health Professional |
|---|
| What might be causing my symptoms? |
| Are there other likely causes? |
| What tests might I need? |
| Will the condition last a long time or improve soon? |
| What are the treatment options? Which one is best for me? |
| Are other treatment options available? |
| How do I handle my other health concerns together with this? |
New questions may come up during your visit, so feel free to ask them.
What Your Healthcare Provider Might Ask
Your health professional will likely ask detailed questions to understand your situation. These may include:
- When did your symptoms begin?
- Are the symptoms steady or do they come and go?
They may also ask:
- How serious are your symptoms?
- Does anything help relieve your symptoms?
- Does anything make your symptoms worse?
- Has anyone else in your family had Bell’s palsy or similar facial muscle problems?
- Do you have signs of a common illness, such as fever or body aches?
Giving honest and complete answers helps your provider choose the best care for you.
Things You Can Do While Waiting for Your Appointment
If you are waiting to see a health professional, you can try some simple steps at home.
For face discomfort:
- Take over-the-counter pain medicine like aspirin, acetaminophen, or ibuprofen.
- Place a moist, warm washcloth on your face to help lower pain. Repeat this a few times each day.
For eye care if your eye doesnโt close fully:
- Gently shut your eyelid often with your finger to keep it moist.
- Use eye drops to lubricate your eye.
- Wear glasses during the day to protect your eye.
- Put on an eye patch at night to prevent your eye from drying out.
