Bell's Palsy is frightening but no life-threatening
DEAR DOCTOR K:
I recently had what turned out to be an attack of Bell's palsy. Can you tell me about this condition?
Bell's palsy is a sudden paralysis involving the nerve that controls the muscles on one side of your face. The nerve becomes inflamed and swollen and stops working properly. All of a sudden, you look in the mirror and see a different face: a drooping mouth, a sagging eyebrow and lower eyelid, and an eye that won't fully close.
Bell's palsy is not life-threatening, but few illnesses are more distressing. Suddenly you look very different. You may have trouble with your ability to speak, taste, eat, sleep or enjoy food. It may cause teary eyes, excess drooling, numbness, ear pain or hypersensitive hearing on your affected side.
Bell's palsy usually begins without warning and develops quickly over the course of hours -- and there's no way to prevent it. The condition is caused by a viral infection that inflames the facial nerve; the most common culprit is herpes simplex, the same virus that causes cold sores (fever blisters).
Treatment usually begins with prednisone, a corticosteroid. This drug reduces inflammation and swelling in the nerve and decreases pain. Initiating corticosteroid treatment within three days of the start of symptoms may increase your chance of a full recovery. I think this treatment should be started in virtually all patients with Bell's palsy, as soon as possible after it starts.
Some doctors prescribe a combination of prednisone and an antiviral drug that attacks the herpes virus. Whether or not the antiviral drugs do much for recovery is not clear. Many of my colleagues here at Harvard Medical School prescribe antiviral drugs, along with prednisone, in severe cases of Bell's palsy. I agree with this.
In the most severe cases, surgery has been performed with the goal of relieving pressure on the swollen and inflamed nerve. Electrical stimulation of that nerve, to try to "wake it up," also has been tried. These procedures are unproven, but they are worth considering in severe cases of Bell's palsy that are not improving with other treatments.
If Bell's palsy is affecting your ability to close your eyes, your cornea can become dry and vulnerable to being scratched. Protect your eyes by wearing glasses or sunglasses. Keep your eyes moist by using artificial tears frequently during the day and lubricate at night with a sterile eye ointment.
Even though the symptoms of Bell's palsy are frightening, there's a good chance your facial nerve will work properly again. Most people start to improve after two weeks and recover completely within six months. The odds that you will experience a complete recovery are greater if the symptoms were milder at the start, and if you began to have improvement in the first three weeks after the condition began.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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